OP RNTE# 04 0D - I L"3~~, Harnett County Department of Public Health 19883
PERMIT # 3 G 7 Operation Permit
-774-- New Installation >13_ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: J ~
Name: (owner) SUBDIVISION Y~,f ~t~, tar. A LOT # I-'f3
System Installer ft_ 0 2 a~ Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water pply: ❑ Community ~Rl. Public ❑ Well Distance from well feet
System Type: JA:h{7 f. !L! h Types V and YI Systems expi n 5 y
(In accordance with Table V a) Owner must contact Health Department 6 s prio o expiration for permit renewal.
Tlns system has been insWW in cm ante with !Pplicable Math Carolina General Statutes, Lies for Senp Treatment ad Di , and all Wdi~om of the Imptoo moot Pmait and Comm t, Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 speafications for the sews a dispos system on the above captioned property.
Type of system: El Conventional Other
k,' ~ Lo ~ --I u c Size of tank: Septic Tank: J gallons Pump Tank; gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ' of each ditch feet ditches . feet ditches inches
French Drain Required: linear feet
Authorized State Agent tr-- Date ti- I-r4 d