OP RHTE# N,,gD3JW Harnett County Department of Public Health 21 3 8 6
PERMIT # '26 ,
C 2?- Operation Permit
( -New Installation CK Septic Tank ❑ RepairCK Nitrification Line ❑ Expansion
PROPERTY LOCATION: IV C. Z)
Name: (owner) rN/1 Cn! SUBDIVISION LOT # ~o C
System Installer. 1-11 ~cQ g Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supp❑ Community $4 Public ❑ Well Distance from well feet
System Type: L A--~/ 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.
Ina system Us peen mstauea in
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mance wIm applicable North Carolma General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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I ~IU III W[WHIVI.J.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No~-X
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional Other ~ t • c It t ( G (n/~r-s-, s Septic Tank: y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch r76 _ feet ditches -3 feet ditches `g q_ inches
French Drain Required: Linear feet
Authorized State Agent
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