OPNTE# o1-,)'= Harnett County Department of Public Health 2 0 6 7 6
PERMIT # a2 v~~ Operation .,Permit
C' New Installation Y Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) SUBDIVISION I oc--kr LOT # 09
System Installer C4".s S'. C,~ -'-4 Registration #
Basement with plumbing. ❑ Garage R" Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ~,4JZ7 Q-, Types V and VI Systems expire in S 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
with applUble North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. 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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: El Conventional In Other 2 F40 Septic Tank: d~ Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a0 feet ditches feet ditches 30 inches
French Drain Required: Linear feet
Authorized State Agent Date Iqla 00
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