OPHTE# O 1 ,J'- -2 ~SZ Harnett County Department of Public Health 2 0 6 9 3
PERMIT # Operation Permit
New Installation 2"Septic Tank ❑ Repair El'-iitri6cation Line ❑ Expansion
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PROPERTY LOCATION: 0/,/ V2
Name: (owner) Ictin q_ ~ A'A - rt 5z SUBDIVISION -3D `X,, r rim LOT #
System Installer d4i(; - c k 4 k4 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community !N Public ❑ Well Distance from well feet
System Type: 7t 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 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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1. 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 spec ations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of r~ exact length
Drainage Field ditches % of each ditch feet
Septic Tank: l 6 gallons Pump Tank: gallons
width of depth of
ditches feet ditches c2 inches
Line
feet
French Drain Required: A
Authorized State Agent . Date
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