OP RHTE# D y') J- I3 I (a(o(t Harnett County Department of Public Health 19 91 4
PERMIT # Operation Permit
New Installation A Septic Tank ❑ Repair'4 Nitrification Line ❑ Expansion
PROPERTY LOUTfOA: `1 X13
Name: (owner) SUBDIVISION (Yll ' Gack'~- LOT # L_
System Installer. C 4 j Nu c- Registration #
Basement with plumbing: ❑ G e Number of Bedrooms Zj
Type of Water ply: ❑ Community IN Public ❑ Well Distance from well feet
System Type: _ Vet 1 i At C\^:oS t-la \7 Types V and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
tins system hat been untal" m compkmce with ap tkk North Carolina General Statutes, Rules for Sewage Treatment and Ditposal, W al cmditiora of the improvement Permit atd (antruct" Audarhahm
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rtam~ Wr1VIi NR):
1. Performance:
11. 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 18
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 u % o T,M t C~) Size of tank: Septic Tank: 13--)3 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ' of each ditch 3 ao feet ditches 3 feet ditches 8 { inches
French Drain Required: Linear feet
Authorized State Agent Date QJ - 0- 3