OPHTE#O°)Harnett County Department of Public Health 2 0 8 2 3
PERMIT # a53b~ Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Ms
Name: (owner) acts 0eRA-) SUBDIVISION LOT #
System Installer: li Z.oww Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Li
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well S feet
System Type: ZIr-! 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.
[his 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 Construction Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No51
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 ~usc C~ar.6E~t Septic Tank: 1006 gallons Pump Tank: gallons
Subsurface No. of exact length %5eo.-4.L5 width of depth of
Drainage Field ditches of each ditch GO feet ditches feet ditches cry-'80 inches
French Drain Required: li r et
Authorized State Agent
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