OP REPAIRHTE# Harnett County Department of Public Health
24098
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PERMIT # Operation Permit
❑ New Installation N„' Septic Tank )N Nitrification Line X Repair ❑ Expansion
PROPERTY LOCATION: 9.34--) Sx Z JOy1 abON 'KD
Name: (owner) .r5r-,aa4 V�"Acz)%JNc. SUBDIVISION LOT #
System Installer: Ql � 5 'SITRegistration #
Basement with plumbing: ❑ Garage ❑ ltrrrhr*�I ca rg
Type of Water Supply: ❑ Community %R Public ❑ Well Distance from well -%0 feet
System Type: � tz Types V and VI Systems expire in S 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 Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
ll. 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
If yes, see attached sheet for additional operation cc
E{ SSs.NC
Fi1G)21 j ��
C1
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Jt3Ez�olaal-sor,a 'P -D
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ 1-1201-ine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
Other C Z �Ld.r
Septic Tank: t�� gallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length -)width
�- of each ditch feet
of
ditches !) feet
depth of
ditches inches
French Drain Required: Lin feet
Authorized State Agent Date % S 6
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