OPHTE# Qq -s- ZZaZb Harnett County Department of Public Health 2 0 4 6 6
PERMIT # Z5-y6L / Operation Permit
5 New Installation R Septic Tank El Repair E Nitrification
Line ❑ Expansion
PROPERTY LOCATION:~t/765- oi,>
Name: (owner) ,o,~//-~ SUBDIVISION ids o s > LOT
System Installer: Registration #
Basement with plumbing. ED] Garage ❑ mber of Bedrooms V
Type of Water Supply: ❑ Community l Public ❑ Well Distance from well feet
System Type: 7S°~a /Z"% UC-n'~" 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.
This system has been installed in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Ru . 61.
II. Monitoring: As required by Rule .1961. LSp
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.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other !5 7t) Septic Tank: / zoo gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of , 40 Drainage field ditches of each ditch I feet ditches 3 feet ditches /i~ -17 ` inches
french Drain Required: Linear feet
Authorized State Ag•-~ Date -7
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