OP RHTE# 0 7. 5-3,) - 1,? , 41(C Harnett County Department of Public Health 19889
PERMIT # a `f 3 l0 2 Operation Permit
~1- New Installation a Septic Tank ❑ Repair ,0 Nitrification line ❑ Expansion
PROPERTY l0(ATION:__ (1 l r
Name: (owner) N-~ v ra ~r •,E > SUBDIVISION C2c S r i c v LOT # (g "f
System Installer. r e D _('Yn Registration #
Basement with plumbing: ❑ Garage & Number of Bedrooms . '3
Type of Water SYly: ❑ Community 54 Public ❑ Well Distance from well 5-0 feet
System Type: ~o C.~ , r t 4 V-- Types Y 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.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No f$/
N yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal sys on the above captioned property.
Type of system: ❑ Conventional F Otfier ! Size of tank: Septic Tank: gallons Pump Tank: galkTns
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch t b feet ditches feet ditches ' 1- inches
French Drain Required: linear feet
Authorized State Agent Date
Trearnent and Uisp%A card alt mrd oohs of du tmporennent Permit and (om uction Authorization.
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