OP R (2)HTE#O t -5 " I 1 Harnett County Department of Public Health 19 616
PERMIT # '`L'1 Operation Permit
Name: (owner) 9, p -c-, ~ y F_►~;t c:~ c.,
System Installer mac t nc ~CgN
Basement with plumbing ❑ Garage '1!~k Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well
System Type: "'t1 b
(In accordance with Table V a)
X New Installation X Septic Tank ❑ RepairA Nitrification Line ❑ Expansion
PROPERTY LOCATION:
SUBDIVISION C_ NZC t_kN Q t-4-5 LOT
'"n v , c•L Registration #
Distance from well t feet
Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in comoame with applicable North Carolina General Statutm, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pemrit and fonstnKtian Authorirarian.
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1. Performance:
ll. 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 s cifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other Size of tank: Septic Tank: I•C)Gr gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch tcr~ feet ditches feet ditches aLt- f4inches
French Drain Required: - feet
Authorized State Agent Date A.) Q1