OP RRHTE# t) -JOD- ► Y-74 22 Harnett County Department of Public Health 2 0 7 5 4
PERMIT # Operation Permit
C>5--New Installat=4 eptic Tank ❑ Rep ) Nitrification Line ❑ Expansion
PROPERTY LOCATION-
Name: (owner) S~~iI C U. l h J SUBDIVISION
LOT #
System Installer. -t c e 'Sf Registration #
Basement with plumbing: ❑ Garage 25- Number of Bedrooms
Type of Water Su ply: ❑ Community ~K- Public ❑ Well Distance from well feet
System Type: 2 F t i T 61
14
Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
[his 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 rnldnlTIAW
I. 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 operatio conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the se a disposal sys em on tt a above captioned property.
Type of system: ❑ Conventional Other' 1 p y Septic Tank: d~ gallons Pump Tank: gallons
Subsurface No. of exact length [ r width of depth of
Drainage field ditches _ of each ditch I ; (D feet ditches feet ditches ) inches
french Drain Required: Linear feet ---t~
Authorized State Agent Date D_)- DG-J- 5
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