OPHTE# C-D9-S- a1i6Y- Harnett County Department of Public Health 20119
PERMIT # Operation Permit
New Installation VSe tic Tank ❑ Re air IK Nitrification Line ❑ Expansion
PROPERTY LOCATION:
G. ~d~
Name: (owner) ce /tloot2 SUBDIVISION LOT #
System Installer. P'l; Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: Zr 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.
ms system naz peen mstanea m compliance wrtn appncable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS: ! Q,, ,
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No BX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: V Conventional ❑ Other
Subsurface No. of / exact length
Drainage Field ditches 1 of each ditch 73
feet
Septic Tank: oqc) gallons Pump Tank gallons
width of depth of
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent w Date a~1
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