OPHTE# Q9 _T o s V 9V Harnett County Department of Public Health 2 0 7 0 7
PERMIT # Operation Permit
LAS New Installation L7 Septic Tank ❑ Repair el"Nitri6cation Line ❑ Expansion
PROPERTY LOCATION: 7-~-
Name: (owner) Mer- tg,` Sc.f~ SUBDIVISION `-+~5•e~~ o; ~fe LOT # `7
System Installer mcj-;dam e~f~ c Registration #
Basement with plumbing: ❑ Garage L umber of Bedrooms
Type of Water Supply: 11 Community Id' Public ❑ Well Distance from well feet
System Type: 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.
ins system nas peen mstauea in
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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PERMIT CONDITIONS:
O
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Following are the specifications for the sewa disposal system on the bove captioned property.
Type of system: ❑ Conventional Other C-_' Z ~/o e~ Septic Tank: gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: \ feet
Authorized State Agent tk--~ Date
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.
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