OP RHTE#a=a-tea c - Harnett County -Department of Public Health 20531
PERMIT t Operation Permit
New Installation Septic Tank ❑ Repairr(, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) W(Lt, ck-- cry ~~c~~~t SUBDIVISION LOT #
System Installer. 0 C- G Q2~ a Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms r
Type of Water Supply: ❑ Community ` l Public ❑ Well Distance from well l00 feet
System Type: _..1o 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.
[his 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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1. Performance:
If. Monitoring:
111. 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'V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property. 1a5o i a3 a
Type of system: ❑ Conventional 'F~11 Other Qo 1 cs -77 0-C cl~ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of ~ depth of
Drainage Field ditches of each ditch feet ditche- s~`--~'- feet ditches N ° aq inches
French Drain Reauired: find fnvt
Authorized State Agent ~ ~ L5 Date 2 1661
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