OPHTE# f6 Harnett County Department of Public Health 2 0 7 7 7
PERMIT # a nL Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
` PROPERTY LOCATION: ~~NCE~N
Name: (owner) fl \
, h►t-a 5 A ~ HS-tcr~ ~cx~b ~s SUBDIVISION 1 ~H P t p cry LOT # 2~-j_
System Installer. Qc•5 S1 IZ-144LP-, 9 Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms
Type of Water Supply: ❑ Community N Public ❑ Well Distance from well feet
System Type: g 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.
mts system nas peen mstanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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1. Performance:
If. 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 K
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal sTstem n the above captioned property.
Type of system: ❑ Conventional Other ~ ` VL-10 w
Subsurface No. of exact length
Drainage Field ditches of each ditch C- C> feet
and all conditions of the Improvement Permit and Construction Authorization.
Septic Tank: tc oc- gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches aIA --3b inches
French Drain Required: e
Authorized State Agent Date 1
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