OP RHTE#1a-s-gYIjk!4 Harnett County Department of Public Health
PERMIT Operation Permit 21 5 4 6
(New Installation ~Se tic Tank CNitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: j-
Name: (owner) "'c,., K T, SUBDIVISION LOT #
System Installer:. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 13
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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
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PERMIT CONDITIONS:
1. 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:
Pts,
Permit and Construction Authorization.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sews disposal system on the Apbove captioned property.
Type of system: ❑ Conventional Other l p'!ti ; 0 / Se tic Tank f
Subsurface No. of P gallons Pump Tank: gallons
exact length width of de th of
Drainage Field ditches 3 of each ditch p
feet ditches feet ditches- inches
French Drain Required: Linear feet
and all conditions of the
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Authorized State Ageo' 1 r. •u 1 C~{f Date ~ it-AZA Qy 6
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