OPHTE# Harnett County Department of Public Health 2 0 5 6 5
PERMIT # s Operation Permit
New Installation '1!~ Septic Tank ❑ Repair , Nitrification Line ❑ Expansion
PROPERTY LOCATION: Rwr ~•oc~
Name: (owner) SUBDIVISION LOT #
System Installer. 1''1E tLe Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community Public ❑ Well Distance from well %00 feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
rnm ~plem nay peen Insiallea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the
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PERMIT rnunlTUUK
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Permit and Construction Authorization.
I. Performance:
II. 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 above captioned property.
Type of system: Conventional ❑ Other Septic Tank: v Oo 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches o each ditch (oO feet ditches feet ditches Ig inches
French Drain Reauired:
Authorized State Agent ~~~~~N O Date 511
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