OP RRHTE# 09-S01) 19'~`~s eAHarnett County Department of Public Health 2 0 5 0 0
PERMIT # T Operation Permit
New Installation Septic Tank ❑ Repair IR~ Nitrification Line ❑ Expansion
f( PROPERTY LOCATION: 2
Name: (owner) C n j , (,<v L cvN t~ SUBDIVISION RAJ 7 L7~11c S LOT #
System Installer. .C- CA~t.~tct+- Registration #
Basement with plumbing. ❑ Garage `i~dL Number of Bedrooms
Type of Water Sppply: ❑ Community Public ❑ Well Distance from well '40 feet
System Type: 1, ~ e '2 u d c C ~r•.---~M UT I, 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.
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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 specifications for the sewage dispos system on the above capti ned property.
Type of system: ❑ Conventional Other W / Septic Tank: j0_ gallons Pump Tank: -[DOO gallons
Subsurface No. of ex ct length width of depth of
Drainage field ditches of each ditch - _11 1 feet ditches feet ditches _lI inches
French Drain Required: Linear feet
Authorized State Agent 7~
Date
ims system has been installed in compliance with applicable North farolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and fonstruction Authorization.
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