OP RHTE# lr.- `oHarnett County Department of Public Health 24442
PERMIT # aq3 Operation Permit
❑ New Installation ❑ Septic Tank X Nitrification Line Repair KExpansion
_ PROPERTY LOCATION: ail flo v J �jQpoK QJxj
Name: (owner) moo. t pej lac N C`1 vwL 00 c\,�- SUBDIVISION ng\ I hrLaa�- LOT #
System Installer: C}> 15 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L—
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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 hm been installed in compliance with apoinble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constmction Authorintion.
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VI III \.VI\VIIIVIV.
I. Performance:
System shall perform in accordance with Rule .1961.
If. Monitoring:
As required by Rule .1961.
111. 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:
`Jc_w 0—cox
V. Other.
Sys c– No e S I aEn —cam
4 $
corn µ0 s a
❑
D -Boz ❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above
captioned property.
Type of system: ❑
Conventional ❑ Other
Septic Tank:
gallons Pump Tank: gallons
Subsurface
��httlser�_
No. of exact length
5
width of
3
depth of
)?
Drainage Field
of each ditch
feet
ditches
feet ditches inches
French Drain Required-
Linear feet
Authorized State Agent `,\, -h5 Date
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