OPHTE# 0°1 -s-x)1-135 Harnett County Department of Public Health 2 0 7 7 5
PERMIT # Ds5 Operation Permit
New Installation 'K Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~tLL CLAz c 1 ~tsME~ SUBDIVISION ~s Poi LOT # I_
System Installer J a r~ sc t~c~~ Registration #
Basement with plumbing: ❑ Garage 'N Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 feet
System Type: 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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wIm appucaoie 1[0[111 larobna beneral statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoK
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: A Conventional ❑ Other Septic Tank: f O o d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches 3 feet ditches dy `30 inches
French Drain Reauired: a_~;,,narr
Authorized State Agent Date