OPHTE# Harnett County Department of Public Health 2 1 17 9
PERMIT # G Operation Permit
-flew Installation tid-Septic Tank ❑ Repait-Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:-1 t3
Name: (owner) SUBDIVISION Y- ,v., L ~c ~ LOT # 1-39_
System Installer c (2~~Numberof Registration #
Basement with plumbing: ❑ Garage Bedrooms
Type of Water Su ply: ❑ Community Public ❑ Well Distance from well feet
System Type:U t t' 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.
...u spicm nas oeen msraneo in compliance with
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: 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
IV. Operation:
V. Other:
maintenance and reporting.
Following are the specifications for the sew disposal stem on tie abpve captioned property.
Type of system: ❑ Conventional Other a C F*Mjtr S Septic Tank: gallons Pump Tank: gallons
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Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ~l Date
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