OPHTE# M- 00-0 K Harnett County Department of Public Health 2 0 6 5 5
PERMIT # a 3~ 3 Operation Permit
❑ New Installation -JZ Septic Tank ~epair El Nitrification Line El Expansion
r C,~ PROPERTY LO(ATION: j I
Name: (owner) ! Y r` ~tY~ I SUBDIVISION G -T K, t Co 2o4c- LOT #
System Installer. W r ~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: Community ❑ Public ❑ Wel Distance from well feet
System Type: (t }L A< 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.
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Ihis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and'alt onditions of the Improvement Permit and Construction Authorization.
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1 Li11111 1-1.11 VI\J.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 4~:Z
If yes, see attached sheet for additional operati
IV. Operation:
V. Other.
maintenance and reporting.
Following are the specifications for the sewage disposal yytem on the above ptioned property.
Type of system: ❑ Conventional ❑ Other \Y~ r Lo- L,- Septic Tank: )COO gallons Pump Tank: gallons
Subsurface No. of exact lengt - width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ~1' Date ~1 - 0
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