OPHTE#_07- a~ Harnett County Department of Public Health 21 122
PERMIT # .ZS" ~ 3, V Operation Permit
11 New Installation E? Peptic Tank ❑ Repair ~itri6cation Line ❑ Expansion
PROPERTY LOCATION: T ar-~ eS /.r?
Name: (owner) SUBDIVISION LOT #
System Installer: C--c- -J fepk: c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community P~Public ❑ Well Distance from well feet
System Type: = g 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.
[his 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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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: 2"Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch DO feet
Septic Tank: /0+0 gallons Pump Tank: gallons
width of depth of t6"-3 (Q 1A
ditches feet ditches /8 inches
French Drain Required: Linear feet
Authorized State Age Date /~Z'! ~iao~
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