OP RHTE# Q 7- 5-- 1 ~9 .3tY1f Harnett County Department of Public Health 19 61 5
PERMIT # X'A I )~3 Operation Permit
Q/'New Installation E~r Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION 4c~ LOT
System Installer721 ,1 , Registration #
Basement with plumbing: ❑ Garage ber of Bedrooms
Type of Water Supply: ❑ Commun Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V al Owner must contact Health Department 6 months prior to expiration for permit renewal.
this s tern has been Mailed in compliance with applicable North Carotin General Statutes, Rules for Sewage Treatment and Disposal, and all condtiom of the knprorement Permit and Construdon Audwiration.
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PERMIT fnunrTlnue-
I. 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 seewwa Disposal system on the above captioned property.
Type of system: ❑ Conventional ;,Other C L i tv+,a Size of tank: Septic Tank: C gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch feet ditches -j feet ditches inches
French Drain Required: linear feet
Authorized State Agen t /It /
~ 7J Date . 7 //C, /2 cef