OP RHTE# O D9 Harnett County Department of Public Health 2 0 6 7 4
PERMIT # 2 y'2 Operation Permit
0' New Installation Ei4eptic Tank ❑ Repair CR"'Nitrification Line ❑ Expansion
PROPERTY LOCATION: S - L6.44 Xj
Name: (owner) a - es SUBDIVISION ~ T,~,:. Lr JOT # QJ
System Installer. rc,ti Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms j-
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type C' Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas peen mstanea in compuance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
1 L-111 W11UMVI1J.
1. Performance:
II. Monitoring:
111. Maintenance:
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 operation conditions, maintenance and reporting.
IV. Operation:
V. Other. a C1 C_
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other _ F~•13.4 Septic Tank: _AA gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of j
Drainage Field ditches f of each ditch ~23 b feet ditches feet ditches v~ Y inches
French Drain Required: Linear feet
Authorized State Age - J - Date T7,-
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