OPHTE# 05 100~ 09N-]i2 Harnett County Department of Public Health 2 0 7 4 2
PERMIT # _Q~3 V7 Operation Permit
New Installati a tic Tank ❑ Rea Nitrification Line
PROPERTY LO(ATION:_ 2)'-
Name: (owner)/ ' SUBDIVISION Jv«~ ' LO
System Installer. ~/Zt J
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: P- 2 00L C/ 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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this system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and fonstruction Authorization
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f L1~1'iil LVIIUI I W1113.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operatt a
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the -ge disposal sy em on th above tinned property.
Type of system: ❑ Conventional Other 1 \Ok Septic Tank: cJ gallons Pump Tank: gallons
Subsurface No. of ~ exact length width of depth of
Drainage Field ditches of each ditch feet ditches- feet ditches _ inches
French Drain Required: Linear feet
❑ Expansion
Authorized State Agent ' } - Date 16 1-
a 7-
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