OP RHTE#_ o s--.o Harnett County Department of Public Health 2 0 9 2 6
15~
PERMIT # ~S Operation Permit
New Installation EIS~ Se tic Tank ❑ RepairpQ~ Nitrification Line ❑ Expansion
PROPERTY LO(ATION:
Name: (owner) k"A '1 f~ Cann r . V) SUBDIVISION bk~x V S1 , ✓t t -LOT # 190
System Installer. c Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _ ;kr s
Type of Water Sup p1 : ❑ Community ~ Public El Well Distance from well feet
System Type: Types V and VI Systems expire in 5 Years. -.L
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(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
a
ims system nas peen mstaneo in
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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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i LI\1111 WR IWIIIVIl[J.
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.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No~
If yes, see attached sheet for additional operation c
maintenance and reporting.
Following are the specifications for the s disposal sys on the ove captioned property.
Type of system: El Conventional them t✓ Septic Tank: ) J ' gallons Pump Tank gallons
Subsurface No. of 71 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 J,-- ~ Date -
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