OP RHTE# I.%~~ i~ Harnett County Department of Public Health 19895
PERMIT # Operation Permit
f New Installation I~eptic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: \\z>T,
Name: (owner) SUBDIVISION LOT #
System Installer. Registration
Basement with plumbing ❑ Garage-16 Number of Bedrooms -3_
Type of Water pl El y Com„ qwn ty Public (71 Well Distan from well feet J t=
System Type: ~ Types V and VI Systems expire in S years. 't ,J) }
(In accordance with Table Y a ~
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Math Carolina General Smtt~ Aides for Sew Tmatment and Di
Sewage sposal, and aA condtiom of tfie
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Permit and Comoudian Authorization,
477-
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 I
IV. If yes, see attached sheet for additional operation conditions, maintenance and reporting,
Operation:
V. Other.
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: El Conventional rt~ Othert`^(~ y 0„ L\< Size of tank: Septic Tank: 6Q, gallons Pump Tank: 0 d G gallons
Subsurface No. of f exact length width of
Drainage Field ditches f depth of
of each ditch 22} feet ditches 3 feet ditches_ inches
French Drain Required: linear feet
Authorized State Agent A, U &:i ~ t~ ~ Date ~ ~ ~ ~
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