OP RHTE# 0 ~ rte, -133 )5 2 Harnett County Department of Public Health 19905
PERMIT # a~ Operation Permit
Hew Installation 4-._Septic Tank ❑ Repair-~ Nitrification Line ❑ Expansion
S PROPERTY LOCATION: __IV( 1_1
Name: (owner) _J~~ ~z c c- SUBDIVISION LOT # T
System Installer.
0 (3 Registration #
Basement with plumbing: ❑ Garage1 Number of Bedrooms
Type of Water pply: ❑ (ommuni Public ❑ Well Distance from well SJ feet
System Type: W tinr V - s t, ,r i1 \-t a Types V and VI Systems expire in 5 years.
(In accordance with Table y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been msWW in
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with applicabk North ("na (several
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W for Sewage Treatment and Deposal, and al conditiorm of the improvement Permit and (ommxtion Atidwzatioa
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PERMIT CONDITIONS:
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:
V. Other.
Following are the specifications for the sewage disposal tern on the above captioned property.
Type of system: ❑ Conventional Other - t H y Size of tank: Septic Tank:
Subsurface No. of ~ gallons Pump Tank: gallons
exact length width of depth of`
Drainage field ditches of each ditch feet ditches feet ditches l a inches
French Drain Required: Unear feet
Authorized State Agent
Date nl?, ~k-3