OPHTE# D"9- s33- Harnett County Department of Public Health 2 0 7 2 8
PERMIT # Operation Permit
d~l....New Installation Se tic Tank ❑ Repa<Nitrification Line ❑ Expansion
PROPERTY LOCATION: _11 ~i )
Name: (owner) 2a -e ~c.t SUBDIVISION fL111 jr d vc LOT #
System Installer (-,r(A (Z-,3L-) Registration #
Basement with plumbing: ❑ Garage A Number of Bedrooms
Type of Water Supp ❑ Community lK Public ❑ Well Distance from well 103 feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system
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nas peen mstaneo in compnance wim appncaote norm taronna aenerat statutes, lsutes for sewage Ireatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. 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 lil
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the seewwaBe disposal s tem on the above captioned property.
Type of system: ❑ Conventional I~ Other "(1" q Septic Tank: \DDO gallons Pump Tank: gallons
Subsurface No. of v exact length width of depth of
Drainage Field ditches of each ditch? feet ditches _ feet ditches inches
French Drain Required: linear feet
Authorized State Agent W Date ~ - `J s -13
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