OPHTE# Harnett County Department of Public Health 2 0 6 7 8
PERMIT # Operation Permit
9?llew Installation Q Septic Tank ❑ Repair a-Nitrification line ❑ Expansion
PROPERTY LOCATION: ,SjKe,,-~ y~ie ,eJ
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing. ❑ Garage ❑ Number of~Bedd oms -_q
Type of Water Supply: ❑ Community ❑ Public Zell Distance from well C1~ 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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This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment Disposal, and all conditions of the improvement Permit ons coon Authorization.
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PERMIT CONDITIONS:
I. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. t o ti6 k ;A 1:~j + f4ct
Following are the specifications for the sews disposal stem on he above captioned property.
Type of system: ❑ Conventional Other Z~F/nv3 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch w feet ditches 3 feet dirrhoc i-hat
rent ram Required: linear feet
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Authorized State Agen Date vZ c "6
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