OP RHTE# 0g - = Z 'I W1- Harnett County Department of Public Health 21 1 5 6
PERMIT # C l~ Operation Plegitt
e "'New Installation Septic Tank ❑ Repair T /Nitrification Line ❑ Expansion
PROPERTY LOCATION:-~.,~
Name: (owner) - c-o, -e- J' sj SUBDIVISION C LOT #
System Installer: i~ Z ON Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 0' Public ❑ Well Distance from well feet
System Type: Zc 6 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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DCDYIT fA UA1T1 A.Ir.
I ~II III VV-IIIV I\J.
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the ssppeeo ((cations for the sewage disposal system on the above captioned property.
Type of system: Id Conventional ❑ Other
Subsurface No. of exact length _
Drainage Field ditches of each ditch S feet
Septic Tank: /00. 0
width of
ditches
gallons Pump Tank: gallons
depth of
feet ditches y inches
trench Drain Required: Linear feet
Authorized State Age aC~ Date !
Imp,
Pam
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