OPHTE# 01-5-~)O- MU q Harnett County Department of Public Health 2 0 6 5 0
PERMIT # Operation Permit
(New Installation C5-- Septic Tank ❑ Repairg Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~e
Name: (owner) Le, S e IS A SUBDIVISION Q~cl LOT #
System Installer: S ran {t t Registration # c rk
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Z
Type of Water Supply: ❑ Community XJ Public ❑ Well Distance from well i03 _ feet
System Type: 775 ~L C G- 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.
ims system nas peen mstaliea in compnance with appuc
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PERMIT CONDITIONS:
North larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. renonnance: system snail perform in accordance with Rule .1 V61.
11. Monitoring: As required by Rule .1961.
ill. Maintenance: As required by Rule .1961. Other. _
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatiol conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the s70 disposal system on the above captioned property.
Type of system: ❑ Conventional ther ! A c [ n a Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of `
Drainage Field ditches of each ditch 2 feet ditches feet ditches f inches
French Drain Required: Linear feet
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Date:
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