OP RHTE# J0- ► 9370 2 Harnett County Department of Public Health 19893
PERMIT # a y 357 q Operation Permit
~*-New Installation 53--Se1~1 Tank 11 Repair, Nitrification Line O Expansion
PROPERTY LOCATION: ( )
Name: (owner) h c Gr3 re_ Qc V. SUBDIVISION C) a ltil~c) CR01i Ads LOT # 2,S
System Installer. % c Q ,1 R 0 LJC\l Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 93 Public ❑ Well Distance fro well JZj feet
System Type: 1 n 14n 1. -v' "I e k t-l 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.
Ties system has ban instaNed in compiasue with appic" Ibrdi Carolina General Statutes, k a to Sew# Treatment and Di , and al conkiom of the ration
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I. 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
If yes, see attached sheet for additional operation a
IV. Operation:
Y. Other
maintenance and reporting.
Fallowing are the specifications for the sew a disposal stem on the above captioned property.
Type of system: ❑ Conventional Other T - Size of tank: Septic Tank: -I NO 0 gallons Pump Tank: gallons
Subsurface No. of 1 exact length width of depth of
Drainage field ditches ( of each ditch --2A2. _ feet ditches . -3_ feet ditches \ ~ inches
french Drain Required: linear feet
Authorized State Agent Date V ~ -0 `6