OP RH T E # aNI Harnett County Department of Public Health 2 0 7 3 5
PERMIT # 2 3 Operation Permit
New InstallatioSe tic Tank ❑ RepaiLp" Nitrification Line ❑ Expansion
PROPERTY LOCATION: I1 5
Name: (owner) ~ 1/_ ~r• SUBDIVISION -7-v g ~r1 t~ c LO
System Installer: Registration #
Basement with plumbing: ❑ Garage kCL Number of Bedrooms
Type of Water Su ly: ❑ Community Public ❑ Well Distance from well D feet
System Type: Vv -V~ _-L C-I n J 'S~~ 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 0
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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Permit and Construction Authorization
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Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: ❑ Conventional 4 Other _ F. ~1) Septic Tank: gallons Pump Tank 43~ U
Subsurface No. of gallons
ex ct length width of depth of
Drainage Field ditches of each ditch feet ditches 3feet ditches inches
French Drain Required: linear feet
`horized State Agent _I,. \ V7~~ Date OG 'U a- 0 q
yr
9
113
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