OP RRHTE#C y-.S--,43-7yHarnett County Department of Public Health 21311
PERMIT # d-QY4 Operation Perpt
O/New Installation R" Se tic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~t- , ,le k v C./
Name: (owner) All- car ~U. SUBDIVISION J L LOT #
System Installer: c~ l ~kc( Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community LiAblic ❑ Well Distance from well feet
System Type: 77r b 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.
mu system nas peen msranea in compuance with applicable North Carolma General Statut s,` for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No fi'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sews disposal ystem on the above captioned property.
Type of system: ❑ Conventional Other c%2 Alder Septic Tank: lz gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 7 feet ditches feet ditches - 18 inches
French Drain Required: Linear feet.
Authorized State Agen/'' eefll _ Date ~
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