OP RHTE#QHarnett County Department of Public Health
PERMIT # > > > Operation Permit 21 61 2
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: :Yurva ~7rL
Name: (owner) Cci N ~2vc.*< %o-0 SUBDIVISION \"Nc,- LOT # 7
System Installer: cy--4 >J Registration #
Basement with plumbing. ❑ Garage'f* Number of Bedrooms 3
Type of Water Supply: ❑ Community '5( Public ❑ Well Distance from well 1C~0 feet
System Type: __T7 T - 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.
niu sptem nos peen mstanea to
with applicable north larobna General Statutes, Rules for Sewage Treatment and
and all conditions of the
PrOMIT rAunlTtnuc.
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Permit and Construction Authorization.
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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.
IV. Operation:
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation co
maintenance and reporting.
V. Other CC) "Eg- Dn c>d tst--r G-2-
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other v+~P i p G~,pe,g~2 Septic Tank: t o o gallons Pump Tank: too<9 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a'-' d feet ditches 3 feet ditches 01- inches
French Drain Reauired:__ l.noa.
Authorized State Agent
Date q 14- ~ 0
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