OPHTE# O f )'00- a1 \43 y Harnett County Department of Public Health 2 0 6 3 7
PERMIT # Operation Permit
,~>Z-New Installati Septic Tank ❑ RepaI04 Nitrification Line ❑ Expansion
PROPERTY LKATION: C
Name: (owner) Pl)l,- ' 4v- wN SUBDIVISION 4,4r LOT #
System Installer: 7: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community L Public El Distance from well _ feet
System Type: t
:Ir
q ~v 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.
Ibis 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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1. Performance:
If. 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 ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal sy~ em on the above captioned property.
Type of system: ❑ Conventional Other I ,IC.< , C F Septic Tank: X7 D gallons Pump Tank: gallons
Subsurface No. of r exact length width of depth of r
Drainage Field ditches t of each ditch feet ditches 3_ feet ditches -4` ( inches
French Drain Required: Linear feet
Authorized State Agent Date 0 LL a y 0
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