OP RRm# Q o,3- ~ mag Harnett County Department of Public Health 19904
PERMIT s~ Operation Permit
4- New Installation 4-Septic Tank M Repair Z Nitrification Line 0 Expansion
PROPERTY LOCATION: Patel
Name: (owner) _SIe~t n (ZC'u o: SUBDIVISION V yo, a-, d ~ z LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage fX- Number of Bedrooms
Type of Water Su ❑ Community ® Public 5~- Well Distance from well 1 00 feet
System Type: - ~ t../ Types V and VI Systems expire in S years.
(In accordance with Table V a) Own most contact Health Department 6 months prior to expiration for permit renewal.
This system has been imtAd in campiantt with aE&abk NuO tuohm C! to es, Wks for Sewap Treatmem ud Dispas4 and >r cmdium of dse kr"anmt Permit ud Cmsuuctiron AutAm =on.
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PERMIT CONDITIONS:
1. Performance:
If. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal tem on the above captioned property.
Type of system: ❑ Conventional * Other 1 spy-o u Size of tank: Septic Tank: IQ 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 11
Drainage field ditches of each ditch feet ditches ~3 feet ditches f irt~h.c
French Drain Required: Linear feet
Authorized State Agent C\' Date l7~ b
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