OPHTE# o~--aag56 Harnett County Department of Public Health 21242
PERMIT # Operation Permit
X New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: '4wy2.1i
Name: (owner) Co~ SUBDIVISION SRrN-U %'r LOT # 2Q.
System Installer~t, c, o~,,a Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t b0 feet
System Type: Ica 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.
ms system as Deen installed m 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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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ N X
If yes, see attached sheet for additional ooeratton rn
maintenance and reporting.
following are the specifications for the sewage disposal system on the above capti ed property.
Type of system: ❑ Conventional Other ,i r Septic Tank: tOOCi gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 300 feet ditches
French Drain Reauired: feet ditches $'3t~ inches
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