OP RRRHTE# 0?- s-') -1'1)1 QTR Harnett County Department of Public Health 21 4 7 5
PERMIT # _,~L: Operation Permit
New Installation VQ_ Septic Tank ❑ Repair 1?~ Nitrification Line ❑ Expansion
PROPERTY LOCATI :
Name: (owner) A- P- ~ SUBDIVISION YA ~h LOT #
System Installer. ~4/' L Registration #
Basement with plumbing. ❑ Garage ~Z_ Number of Bedrooms 'h*
Type of Water Sup ly: ❑ Community ❑ Public ❑ Well Distance from well _ 22 _ feet
System Type: Z F \ 0w c, 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.
~ - ~ptcm nm neen mssanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional #-Other 'L-2 ~__\D\j Septic Tank:
gallons Pump Tank: gallons
Subsurface No. of ` exact length width of depth of
Drainage Field ditches t of each ditch -.2-12_ feet ditches
French Drain Required: feet ditches- inches
Linear feet
Permit and Construction Authorization.
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Authorized State Agent ~ _NLls! ti ~ Date 0 w V 0
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