OP RHTE# dHarnett County Department of Public Health 212 6 9
PERMIT # Operation Permit
New Installation Septic Tank D Repair Nitrification Line El Expansion
PROPERTY LOCATION: N~`1
Name: (owner) Per-.~.cclc,a«rCisr,~~ct~ SUBDIVISION
LOT # Z-I
System Installer: 9,,r✓~s~f V- t' U~Ns, Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 (n0 feet
System Type: 13 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.
111spteni nas peen mstaueo In wmPiance with applicable North tarolma General Statutes Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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. W o,VEn, t-~r.E Syt v eo
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional U Other 9 yr~4 5:Z Septic Tank: 1000 gallons Pump Tank: 1004 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc a of each ditch a6~ feet ditches 3 feet ditches inches
French Drain Reauired:. (moo ar foot
Authorized State Agent N\ 'N N ~ eu 5 Date
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