OPHTE# ofl -s-a Harnett County Department of Public Health 21228
PERMIT # ~5~~°► a- Operation Permit
New Installation '5~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Pa~~snj, .5 .v,
Name: (owner) WR~S~-or.t t-oo,E
l,,nt3A SUBDIVISION C1~r~ r- Ez- LOT # t n
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community IN Public ❑ Well Distance from well f 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.
ims system nas been mstanea in
with applicable 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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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
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: ❑ Conventional Other avsa_4 rtBE Septic Tank: 600(1 gallons Pump Tank: 1000, gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch aa•Q feet ditches 3 feet ditches Ik inrhrs
French Drain Required: r feet
Authorized State Agent Date 110
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