OP RHTE# Qx-' ,)D - a~33to~ Harnett County Department of Public Health 2 0 7 2 4
PERMIT # S 3 Operation Permit
Clew Installations Septic Tank ❑ Repaid Nitrification Line ❑ Expansion
PROPERTY LOCATION: I 2
Name: (owner) SUBDIVISION c ' LOT #
System Installer: C CAr'- - Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 2> C?~
Type of Water Suppl ❑ Community ❑ Public ❑ Well Distance from well _0::;)_ feet
System Type: _ "I '4 t Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewa a Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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~ 11111 1. V 1~ Y 111 V I110
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No C
If yes, see attached sheet for additional operation c
IV. Operation:
itions, maintenance and reporting.
V. Other.
Following are the specifications for the sewa disposal syst on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank gallons
Subsurface No. of V exa t length width of depth of
Drainage Field ditches of each ditch - feet ditches feet ditches 1i V Z ~ inches
french Drain Required: Linear feet
Authorized State Agent Date 01)x b
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