OPHTE# c?7- 5;00- ( ~ 111 Harnett County Department of Public Health 2 0 9 2 3
PERMIT # Operation Permit
New Installation 4~1, Septic Tank ❑ Repair tR Nitrification Line ❑ Expansion
J PROPERTY LOCATION: Z -A C c 9cl
Name: (owner) SUBDIVISION LOT
System Installer +!17eg!j (vl,~o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Su ly: ❑ Community . k Public ❑ Well Distance from well too feet
System Type: lw s r k a Types V and VI Systems expire in 5 years.
(In accordance wit Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims sysam nas peen mstaneo in
vnm apphcawe 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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CONDITION-
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OP,vl Performance: System shall perform in accordance with Rule .1961.
Monitoring As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No $0
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional .129 Other A t C G< L_t Septic Tank: J gallons Pump Tank: gallons ItA Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch t~ feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent 9,30-3 Date ~-ti(1 l
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