OP R9E# ,0 -s L~Zyp/Z Harnett County Department of Public Health 21064
PERMIT # 2Gog~' Operation Permit
❑ New Installation ❑ Septic Tank ❑ Repair 2/Nitrification Line L/ Expansion
PROPERTY LOCATION: ~,c 7yiL k,,,s l 0-/Z-6
Name: (owner) Ie~/a~ a o, SUBDIVISION N►r~_1 s N1 ~vr 7 LOT # 7_
System Installer T Registration #
Basement with plumbing: ❑ Garage /~~umber of Bedrooms
Type of Water Supply: ❑ Community (J 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.
tors 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.
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IQ 1412 Chn.,;,S L~0- /Zb
DCDYIT fA\IrlIT1A\If.
1. 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 'fcations for the sewage disposal system on the above captioned property.
Type of system: speConventional ❑ Other
Subsurface No. of exact length <v
Drainage field ditches Z, of each ditch G D feet
Septic Tank: gallons Pump Tank gallons
width of depth of
ditches 5_ feet ditches 7-4- inches
French Drain Required: Linear feet
Authorized State Age Date /y-/Z /y
61
1111111W 1,
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