OPHTE# 61-~~ ~ - I 1-i t f Harnett County Department of Public Health 19 817
PERMIT # a 4 2 r'1 Operation Permit
--New Installation 5r- Septic Tank ❑ Re air N~J Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION
Ali System Installer: Q2~ u~ ( LOT #
Registration #
Basement with plumbing. ❑ Garage 59 Number of Bedrooms __L_
Type of Water S 11 Communih Pupplic El Well Distance from well 50 feet
Sm Type:. I't4Lp 7 t f Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
mss -Sptem his been mstakd in compkwe with apoirabit Math Carolina Gew-A Strutes, Rules for Sew T-m*m and tAsposal, and al mnditicm at the Improvement Permit and Conshucoan Audsoru 6m
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I. Performance
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961. K'
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Y. Other.
Subsurface system operator require0 Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal !stem on the above captioned property.
Type of system: ❑ Conventional Other u - t h Size of tank: Septic Tank: t7 gallons Pump Tank: 00o gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch } feet ditches feet ditches ' 2' inrhec
trench Drain Required: linear feet
Authorized State Agent c ~ Date >I