OPHTE# t -S- ;O cUY Harnett County Department of Public Health 2 0 9 8 4
PERMIT # 4I
Operation Permit
..New Installation -&L Septic Tank ❑ Repair Q_- Nitrification Line ❑ Expansion
PROPERTY LOCATION: 131
Name: (owner) 1 C,. P,, .yam SUBDIVISION 1 LOT
System Installer. L . S ~'A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: Community Public ❑ Well Distance from well /3.5 feet
System Type: n f.'. L 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.
nns system nas peen mstanea in compliance with applicable North Carolina General Statutes, Rules for Sewagg Treatment and
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Permit and Construction Authorization.
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and all conditions of the
DCRMIT rALMITIAIIt.
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I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional '1~ Other 1M g- 31, Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch - feet ditches feet ditrhec
rent ram Required: Linear feet
Authorized State Agent Date Okv~ Z-- A7 -
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