OPHTE# U 9- ~t s-q Harnett County Department of Public Health 21 1 5 7
PERMIT # Operation Per it
New Installation Septic Tank ❑ Repair C~Nitriffcation Line ❑ Expansion
PROPERTY LOCATION: a ~roTd.,~v.~d
Name: (owner) SUBDIVISION PQf-}-~~: ~~of` LOT # f /
System Installer: J Bv:Registration #
Basement with plumbing: ❑ Garage EiKNumber of Bedrooms 3
Type of Water Supply: ❑ Community E41"'Public ❑ Well Distance from well feet
System Type: lir 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.
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
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If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sews~tsposal Vstem on thp above captioned property.
Type of system: ❑ Conventional 1?1 Other t- Z ~ c Septic Tank: /o(1 U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch S~V feet ditches -3 feet ditches 16 inches
French Drain Required: Linear feet
Authorized State Agen : ~c Date 1--2- 2,
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