OPHTE#°~~~1 Harnett County Department of Public Health 2 0 7 7 6
PERMIT # a5\9q Operation Permit
New Installation "N Septic Tank 0 Repair Nitrification Line 0 Expansion
PROPERTY LOCATION: 1 in~grr Q t~
Name: (owner) g.~,~ ~or. Es SUBDIVISION
System Installer. yo Nes S S LOT # t~_
Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community \X Public ❑ Well Distance from well n- 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.
~Picm aw veers uuianea in compuance wan applaaole north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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D[QMIT fA11A1TI UC
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
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: Conventional 'Other C!"o c,,\ e,e~.2 Septic Tank: N o oa gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f each ditch 1'r feet ditches feet ditches inches
French Drain Reouired: A oae
Authorized State Agent S Date Gl1
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