OP Rk a_? HTE#_ K- 3__ Harnett County Department of Public Health 20713
PERMIT # ar• 9 3 Operation Permit
E hew Installation C-- eptic Tank ❑ Repair [?'"Nitrification Line ❑ Expansion
PROPERTY LOCATION: d c a c tis° t.
Name: (owner) SUBDIVISION L per- , C~,r,r.r LOT # °r-'
System Installer:_ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 31
Type of Water Supply: ❑ Community e Public ❑ Well Distance from well feet
System Type: 7i7 6 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.
un sysum nas oeen msraneo in compuance wtm appucaoie norm l.arouna beneral Statutes, Rules for Sewage Treatment and
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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Subsurface system operator required? Yes ❑ No L~~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Others^t'
Following are the specifications for the sew3gp- s stem on the above captioned property.
Type of system: El Conventional 1J Other y : C k Septic Tank: gallons Pump Tank: /do a gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 60 feet ditches feet ditches 00 inches
Authorized State An Date Lv~L. _4 1~02 and all conditions of the Improvement Permit and Construction Authorization.
French Drain Required: Linear feet
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