OP RHTE# Cf% s-a 6~ Harnett County Department of Public Health 21270
PERMIT #
a7 S Qperation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1A,-,-) G ".4
Name: (owner) x•c~~ \Aos,~,z, S-7~4SUBDIVISION -V-, cE,,, ~Qa~ LOT # 'R I
System Installer: 12 Registration #
Basement with plumbing: ❑ Garage 'N Number of Bedrooms 3
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well t.hd feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
,it,, ,lxeru om ueen ms[aneo in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT rmmnITIAM(-
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I. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional I Other Pn w >r i 8 ~0~~ C 0 Septic Tank: I O O(7,, gallons Pump Tank: I !Z! c-, 0 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 0' feet ditches 3 feet ditches aa, inches
French Drain Reouired: - . w pN'6p+
Authorized State Agent 9kr-5 Date 31.1) K)
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