OPHTE# ❑-0 7'~7 Harnett County Department of Public Health 21 18 3
PERMIT # Operation Permit
New Installation t'c- Septic Tank ❑ Repair ly- Nitrification Line ❑ Expansion
PROPERTY LOCATION: J't2 1 1
Name: (owner) G't rn /
SUBDIVISION } rz1 LOT #
System Installer. --t Rat- Registration # - -1l
Basement with plumbing. ❑ Garage $4 Number of Bedrooms
1& 4
Type of Water Sup fly: ❑ Community t54- Public ❑ Well Distance from well
System Type: k f . feet
1 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner At contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes liul r Sewage Treatment and D sposal, and all conditions of the Improvement Permit and Construction Authorization.
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V
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
b
A AA A
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No`9' If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sews disposals m on the above captioned property.
Type of system: ❑ Conventional Other ~,A , t1 %4
Subsurface No. of Septic Tank: gallons Pump Tank: gallons
Drainage Field ditches Li of exact each length ditch feet width of depth of
Vt
French Drain Required: Linear feet ditches feet ditches _ ~ inches
Authorized State
Date C)3 o\ -
1 ~ 1 }
A t Rs 7 k i a, r'74
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