OPH T E # CV - Jo • 130
Harnett County Department of Public Health 2 0 5 7 5
PERMIT #2 Sa~ 2 Operation Permit
5~- New Installation Septic Tank ❑ Repair ~Z Nitrification Line ❑ Expansion
PROPERTY LOCATION: H-11) ST CI„ 1~, A
Name: (owner) Persons SUBDIVISION - LOT #
System Installer: 2 J Registration # 3 /A C
Basement with plumbing: ❑ Garage Number of Bedrooms L f
Type of Water Supply: ❑ fommunity Public ;R- Well Distance from well feet
System Type: E -7 F ht / ~ 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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This system has been installed in compliance 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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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatio conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above ca tioned property.
Type of system: ❑ Conventional Other 7 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 3 nJ feet ditches feet ditches 2- inches
french Drain Required: Linear feet
Authorized State Agent I Date