OPHTE#-C) K _~')o' )1 31., z Harnett County Department of Public Health 2 0 6 4 0
PERMIT # Operation Permit
InstallatioTc;-~ptic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATIO • 121
Name: (owner) ~~cti-fir ~ c~ {~n~c 2 SUBDIVISION ers'n C'."
f )t LOT # -7C.
System Installer: Fi/ -q v Registration #
Basement with plumbing. ❑ Garage gl Number of Bedrooms - :5
Type of Water Supply: ❑ Community,_❑ Public ❑ Well Distance from well feet
System Type: 1.17 G 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 system nas peen mstanea in
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Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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 spe
cifications for the sewage disposal system on the above captioned property.
Type of system: ❑
(onventional" Other (J , c V y
Septic Tank: gallons Pump Tank: gallons
Subsurface
Drainage field
No. of exact length
ditches ' of each ditch) feet
width of depth of
ditches !3_ feet ditches l inches
French Drain Required: Linear feet v
Authorized State Agent Date D) 3D- C)q
ance with appucawe north laroima heneral Statutes, Rules for
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