OP RRRHTE# M-Sbc,47 0- FQ-¢- Harnett County Department of Public Health 20981
PERMIT # Operation Permit
. New Instal latiorj Septic Tank ❑ Repair ~~titrification line ❑ Expansion
PROPERTY LOCATI 5
Name: (owner) ~~{1Ct «J SUBDIVISION _ 2- LOT #
System Installer. Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ mmunity 5k Public ❑ Well Distance from well feet
System Type: t- 2 F~ aw 'C C/ 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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ims system nas peen mstanea in compliance with applicable North [arolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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I. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961. z-
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the sew ge disposal systee on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: 330 gallons Pump Tank: gallons
Subsurface No. of 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 t I , U 11 4rlw Date 9 ` 2 `3 1
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