OPHTE# cx~ Harnett County Department of Public Health 2 0 7 8 9
PERMIT # a~ Operation Permit
New Installation N Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LO(ATION: J HMV- 1 0
Name: (owner) -)t gc- -y j QoP~-- SUBDIVISION Eo~~~ ~ ~3P~ty LOT #
System Installer: Z jt V^N-r%- UA 5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l bb feet
System Type: 3ts-- - 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.
ims system nas oeen mstaneD to
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.
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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional -'I!~ Other ~ Z Septic Tank: 111300 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch IOC feet ditches -.3 feet ditches L1`0 inches
French Drain Required:
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Authorized State Agent \ ~ tZ Date