OPHTE#0 1- 5-0 al G"3L Harnett County Department of Public Health 2 0 6 4 9
PERMIT # Operation Permit
Y- New Installation ~Se tic Tank ❑ Repair` Nitrification Line ❑ Expansion
PROPERTY LOCH IT ON:
Name: (owner) clmr%-"s ^6 f SUBDIVISION c LO'
System Installer. 51 (L v c V A Registration #
Basement with plumbing: ❑ Garage 1 Number of Bedrooms
Type of Water Supply: Community Public ❑ Well Distance from well feet
System Type: '7 f%I ~w '7 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other - 2 (7 \-0~-j 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 -Vu~ Authorized State Agent ~ Date 0 LJ
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