OPHTE# V4'-S - ZI 7FS Harnett County Department of Public Health 2 0 4 6 8
PERMIT # 2S I t-t 77 Operation Permit
New Installation 2' Septic Tank D Repair LJ- 'Nitrification Line ❑ Expansion
PROPERTY LOCATION:-*e1,Vs/7,*PyA cl,4 1*7,6
Name: (owner) 1 1Jp M SUBDIVISION 69f` LOT #
System Installer: Ro /0 t.) 4-1Registration #
Basement with plumbing: ❑ Garage ~~'mber of Bedrooms ~ ~
Type of Water Supply: ❑ Community l Public ❑ Well Distanc r feet
System Type: ~o Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ner mustcon t Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina GenerarStaVes, Rules for Sewage treatment and
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
and all conditions of the Improvement Permit and Construction Authorization.
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Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sews disposal system on the above captioned property. G ~ZU~
Type of system: ❑ Conventional Other 191,0,~DOF UZ ~ . ~sr Ti Septic T1nk: 1050 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ,
Drainage Field ditches of each ditch Z16 feet ditches feet ditches 3d inches
French Drain Required: ~tLinear feet
Authorized State Agen C Date ' 2 2 i
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