OP RRHTE# Q2~ Harnett County Department of Public Health 2 0 7 5 3
PERMIT # Operation Permit
New Installation CSe tic Tank 1:1 Repait~, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Si t a, 1J, i SUBDIVISION (21, A 111 LOT # I qO
System Installer: 0- \ 4'g Registration #
Basement with plumbing: ❑ Garage.4-Number of Bedrooms --7-
Type of Water Supply: ❑ Community -,Z- Public Wel Distance from well 120 feet
System Type: / U 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.
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This system has been installed in compliance with applicable 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:I
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. 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 a disposal system on tote above captioned property.
Type of system: ❑ Conventional Other C • I ( 1 J✓ Septic Tank: 23 j gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 J feet ditches- feet ditches inches
French Drain Required: linear feet
Authorized State Agent Date t71 `7
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