OP RRHTE# 0 oj-►t-75 7 cv Harnett County Department of Public Health 20751
PERMIT # 2`1 D Operation Permit
-t4ew Installation,, -septic Tank ❑ RepalrCRL- Nitrification Line El Expansion
PROPERTY LOCATION: N (XI,
Name: (owner) n n C -A SUBDIVISION '~~,cr~ LOT # )
System Installer: A Registration #
Basement with plumbing: ❑ Ga ge Number of Bedrooms _73_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well -I ~j feet
System Type: k 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 applic
No I
North Carolina 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:
11. 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.
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Subsurface system operator required? Yes ❑ No
Of-
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal sys em on the above captioned property.
Type of system: ❑ Conventional Other - t, Septic Tank: 103-) gallons Pump Tank: gallons
Subsurface No. of / exact length width of depth of
Drainage Field ditches of each ditch) feet ditches feet ditches_ inches
French Drain Required: Linear feet
Authorized State Agent Date
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