OPHTE# 0 q~S = AOa8i Harnett County Department of Public Health 21 1 4 0
PERMIT # Uperatlon Permit
New Installation K Se tic Tank ❑ Repair El'- Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 7 f -r o,w M a c.lt SUBDIVISION LOT #
System Installer: /y Fs Fce..~ c fti Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Communi ❑ Public K Well Distance from well /00 feet
System Type: ~ 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.
inu srsiem has peen mssaieo in compoance wan appucawe north tarouna beneraf Statutes, Roles for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
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V. Other. J7 rj k 4- U -0- X QK-
Following are the specif tions for the sewage disposal system on the above captioned property.
Type of system: L'1 Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches- of each ditch feet
Septic Tank: /NQ gallons Pump Tank: _
width of depth of
ditches feet ditches
L4?t
_ gallons
inches
French Drain Required: Linear feet
Authorized State Agent Date a2 ° lQ