OP RHTE# ~o-s'-z35z`,7 Harnett County Department of Public Health 21070
PERMIT # zoos Operation- Permit 1
1New Installation LEI Septic Tank ❑ Repair LI Nitrification Line ❑ Expansion
PROPERTY LOCATION:&17, ) Dial sj
Name: (owner) SUBDIVISION beer-2t ?,QWy~'.ttn:.-.,_ LOT # /Z
System Installer: srt6 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 2sm* EA&&fo,~ T, = 4V 6ZC.~ 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.
Ims sysrem has peen Instanea in compnance with
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north Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the
Permit and Construction Authorization.
i Ln111 LV11VI11Vl\3.
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:
V. Other:
Following are the specifications for the sews disposal system on the above captioned proper.
Type of system: El Conventional Other 11M IZAt) C-4f S Septic Tank: 100 5 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches Z of each ditch lIX a feet ditches 3_ feet ditches L 9. -19 inches
French Drain Required: ~Linear feet
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