OPHTE #
Harnett County Department of Public Health 21247
PERMIT # Operation Permit
New Installation N Septic Tank ❑ Repair"g Nitrification Line ❑ Expansion
PROPERTY LOCATION: R,_ '()cL-,
Name: (owner) ~t C-- Lx- ~locn 5 SUBDIVISION T„b svmr,LOT #
System Installer: _ Cr~,S S-,cL,c.c.Lv~p Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community 15< Public ❑ Well Distance from well too feet
System Type: '.-CM 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 peen mstaneu in compliance with
North Carolina General Statutes, Rules for Sewaee Treatment and
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Permit and Construction Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 C~- ~L Septic Tank: I Oo C) gallons Pump Tank: gallons
Subsurface o. exact length width of depth of
Drainage Field ditches - of each ditch -7 C~ feet ditches 3 feet ditches al~ 3b inches
French Drain Reouired: E. star
Authorized State Agent ► y,ts Date ~ 1171 lV
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