OPHTE# Harnett County Department of Public Health 21 18 2
PERMIT # Operation Permit
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F~ New Installatiod--'-'N Septic Tank El Repair 16-,rificatlon Line ❑ Expansion
I € PROPERTY LOCATION:
Name: (owner) ~rl' ns SUBDIVISION '/j iv -r_~ LOT #
System Installer: at Registration #
Basement with plumbing: ❑ Garage . Number of Bedrooms
Type of Water Supp ❑ Communit~y} Public ❑ Well Distance from well feet
System Type: k LL _,kl A_ ~ rr 1 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and al
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conditions of the Improvement Permit and Construction Authorization.
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DCDMIT rn11nIT1A11C.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N -
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: h i,v,t~ k1A 7 0a :3✓-r Lth~ l/~ -~4-J Q - ttvr liV
rV Pr ~7 to l~,tl~/~lZl~
V. Other.
Following are the specifications for the sXg e d isposal sy1em on the above captioned property.
Type of system: ❑ Conventional Other .0, 1, 0'. , V q C il' Septic Tank: ID gallons Pump Tank: gallons
Subsurface No. of exact length `I width of depth of
Drainage Field ditches -t of each ditch [ G feet ditches 3 feet ditches 0 inches
French Drain Required: Linear feet
Authorized State Agent n 4~ Date
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