OPHTE# Ct-5-aa40j Harnett County Department of Public Health 20810
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Y r4 N Co N U C..-r\ O)a SUBDIVISION `Ti m c ~.t Qo ~ ,,c-r LOT # 2
System Installer: Q. oy (3pnymN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community )i( Public ❑ Well Distance from well 100 feet
System Type: b 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.
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PERMIT rAkJrIITIAMC.
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Permit and Construction Authorization.
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 ❑ N
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: X Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditc of each ditch feet
French Drain Required Nlinear feet
with applicable North Carolina General Statutes, Rules for Sewave Treatment and
roa `
Septic Tank: IAab gallons Pump Tank: gallons
width of depth of
ditches feet ditches &tll inches
Authorized State Agent "N\- Date 91 a'd 6
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