OPHTE# 0" ' fb ~ - ai z3z- Harnett County Department of Public Health 2 0 7 5 2
PERMIT #~'z Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATIO :
Name: (owner) SUBDIVISION C ens LOT
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Su I Y. ❑ Community Public ❑ Well is nce from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owne must contact Health Department 6 months prior to expiration for permit renewal.
ims spstem nas peen mstanea in compliance with
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North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the
ement Permit and Construction Authorization
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PERMIT CONDITIONS:
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r rl f mame. orxem snau perform in accordance wltn We l yb i,
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
IV. Operation:
V. Other.
maintenance and reporting.
Following are the specifications for the sew a disposal em on the above captioned property.
Type of system: ❑ Conventional Other 11', A I r 1/ L~ 3
~ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ~f
Drainage field ditches of each ditch _ feet ditches feet ditches 190' `Tl inrhec
French Drain Required: f Linear feet
Authorized State Agent Date all ~j
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