OP RfaE# C;--) Harnett County Department of Public Health 19870
PERMIT # Operation Permit
Ed New Installation E Septic Tank O Repair Nitrification Line C-1 Expansion
PROPERTY LO(ATION: arc//sy ~j~-sE 21~
Name: (owner) h41 tl ~y6if>25 SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community I( Public ❑ Well Distance from well _ feet
System Type: T) Z t Types V and YI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal,
ims system nas peen msum in compeance with appbcaW North tarohna General Statutes, Rules for Sewage Treatment and
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and all cwditiom of she Improvement Permit and eonsbudon Authorization
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1. Performance
II. 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 sews disposal system on the above captioned property.
Type of system: El Conventional 13 Other Z5%kt)Ocai) ~5i,t>lr, Size of tank: Septic Tank: lOC) ) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch . LCD feet ditches _-7 feet ditches 36 inrhoc
French rain Required: Linear feet
Authorized State Age 1 Date i 3 6