OP RHTE# /V-'5- Harnett County Department of Public Health 2 0 91 1
PERMIT # z~7F Li Operation Permllt
E~( New Installation 1 Septic Tank ❑ Repair R '/Nitrification Line ❑ Fxnancinn
PROPERTY LOCATION:
Name: (owner) ~~,,..SUBDIVISION LOT # j_
System Installer: J*-, Registration #
Basement with plumbing: ❑ Garage ❑/Number of Bedrooms N
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: Z5'% FZ~~DV~f~tt1 s ~3 tT',~ T G ~ 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.
This system has been installed in-compliance 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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PFRMIT runlTlnW-
I. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the seewws;'disposal system on the above captioned property.
Type of system: ❑ Conventional L~f Other 29`4 (L/ l3! F7 u~-- Septic Tank: /Z'0 gallons Pump Tank: gallons
Subsurface No. of _ exact length width of depth of
Drainage field ditches 5 of each ditch a feet ditches j feet ditches inches
French Drain Required: Linear feet
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