OPHTE# D 6-~ , 3-;n}-) Harnett County Department of Public Health 20641
PERMIT # Operation Permit
New Installation oZ1-Septic Tank ❑ Repair k;~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: 21j
Name: (owner)~_"~ SUBDIVISION ~e r LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Su1ly: ❑ Community E4 Public ❑ Well Dista ce from well feet
System Type: tf ~t~`Yr ~c Y / Le Z
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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[his 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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DCDMIT rA111LTVn1I(.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatio
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewage disposal sy em on the above captioned property.
Type of system: ❑ Conventional ~i Other, t F~ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches _-of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
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Authorized State Agent , 1 Date 7) bfl- 0 CK-0
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