OPHTE# cL-_-/1f,7 a Harnett County Department of Public Health 19 61 0
PERMIT # I) S_ Operation Permit
3-'New Installation HIleptic Tank ❑ Repair a "Nitrification Line ❑ Expansion
PROPERTY LOCATION: 5l- /1/-L
Name: (owner) SUBDIVISION «t~r Crei k LOT
System Installer. e s <f Registration #
Basement with plumbing. ❑ Garage NCB} tuber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: ]U- G Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been instaw in comoince with aWkabk North fauna General Statutes, W for Sew Treatment ad Disposal, asd an conoitiom of the emmt Permit and fomtruaw Audrorintton
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No kl~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewap disposal system on e above captioned property.
Type of system: ❑ Conventional Other Z r aw Size of tank: Septic Tank: Oct U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch Q feet ditches .3 feet ditches i E - ? 1' inches
french Drain Required: linear feet
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Authorized State Agent > _ Date j12- Z Z C