OP RHTE# N- _ q 0 9, Harnett County Department of Public Health 2 0 7 5 7
PERMIT # Operation Permit
--New Installatio Se tic Tank ❑ Rep Nitrification Line El Expansion
Cam; ` l PROPERTY LOCATION: III A
Name: (owner) (~(1 C , ` 1 t t (1 -1 UIRnfultlnN 0,. \1, ~ t
System Installer. + C 1 c c 1 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms '3
Type of Water SuppI : ❑ Community Public ❑ Well Distance from well feet
System Type: -'2 TI A.Z 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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nos 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 CONDITIONC-
L 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
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the se ge disposals em on he above captioned property.
Type of system: ❑ Conventional Other Septic Tank: J 2 gallons Pump Tank: gallons
Subsurface No. of exact length r width of depth of
Drainage Field ditches of each ditch- feet ditches 3 feet ditches inches
French Drain Required: - _ Linear feet
Authorized State Agent-
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