OPHTE# c- S ~D Harnett County Department of Public Health 2 0 6 4 8
PERMIT # Operation Permit
New Installation --Septic Tank ❑ RepairiZf, Nitrification Line ❑ Expansion
Name: (owner) ;fit W PROPERTY LOCATION:
t SUBDIVISION J,~; S, , r-c
LOT #
System Installer ttii ► 41~ti Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms Lj
Type of Water Supply: ❑ Community $4 Public ❑ Well Distance from well "3 feet
System Type: ' I 1 *1~ ~,C 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.
um sptem rim ueen mstaneo in compnance with applicable Norm Carohna General Statutes Rules for Sewage Treatment and
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and all conditions of the
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DCDMIT rAMAIT1Atl[
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Permit and Construction Authorization.
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I. Performance:
11. 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
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the shove captioned property.
Type of system: ❑ Conventional ( Other s. 'L t- v+~ Septic Tank: - gallons Pump Tank: gallons
Subsurface No. of exact length t width of depth of p
Drainage Field ditches of each ditches feet ditches feet ditches `s inches
french Drain Required: ( Linear feet
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Authorized State Agent A~ Date '
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