OP RRRHTE# t )`12~z(Z-11 Harnett County ttDepartment of Public Health 2 0 6 5 2
PERMIT # a'41 ~ Z Operation Permit
Ole- New Installation Septic Tank ❑ Re1:16K Nitrification Line F-1 Expansion
PROPERTY LOCATION: 2
Name: (owner) %t S c[' SUBDIVISION LOT # ('i5-
System Installer: Registration # O«1, F
Basement with plumbing: ❑ Garage 4-Number of Bedrooms A/ nom eu- C:
Type of Water Supgly: ❑ Community Public ❑ Well Distance from well o feet
System Type: (c IT b 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.
nos srsmm nas peen mstauea in compuance wnn appncanle North laroima General Statutes Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
If yes, see attached sheet for additional operatic
L(a611
conditions, maintenance and reporting.
Following are the specifications for the sewage disposal sygem on the above captioned prope'
Type of system: ❑ Conventional -Other i"V C!.o :t'
t~~, < l~ Septic Tank J~ J gallons Pump Tank: o J gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches _ feet ditches I Y inrhm
French Drain Required: linear feet -
Authorized State Agent V Date o~' C
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