OPNTE# (39 -5-aC3;)11 Harnett County Department of Public Health 21 2 5 5
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair'X Nitrification Line ❑ Expansion
PROPERTY LO(ATION: $ FG~s a 1-a~ E
Name: (owner) HN~~ Cvmm,Nc-s SUBDIVISION `TAB LOT # )5a
System Installer: O~ is S1 2~c u ~ D Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t0 D feet
System Type: ZTt 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.
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Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Role .1961.
As required by Rule .1961.
As required by Rule .1961. Other, _
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other G Z Fw W Septic Tank: t ~d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _ 13 C) feet ditches 3 feet ditches 30--J14 inches
French Drain Required: r feet
and all conditions of the
Authorized State Agent -N- Date 6L,19
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