OP RHTE# D P~--)ci-7g6 Harnett County Department of Public Health 21 3 8 3
PERMIT # Operation Permit
CD~-4ew Installation C,"*-,Septic Tank ❑ Repair(ST` Nitrification Line ❑ Expansion
PROPERTY LOCATION: _&C a
Name: (owner) ~J' A~ Gil) SUBDIVISION `v✓ ors LOT # i
System Installer: - BAA4 t Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water S ply: ❑ Community Public ❑ Well Distance from well _j O 3 _ feet
System Type: t. r L 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.
ims system nas peen mstahea in
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Na~
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications sewage dispos system on the above captioned pr~op~rty
Type of system: ❑ Conventional - - , I - `~L
Subsurface No. of length
Drainage Field ditches of e h jnD feet
French Drain Reauired:,
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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Septic Tank 390 gallons Pump Tank: IQP6 gallons
width of depth of
ditches -feet ditches inches
Authorized State Agent Date i )Z ~1 0
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