OPHTE# cs~--~,~a Harnett County Department of Public Health 21 2 6 4
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
PROPERTY LOCATION: N
Name: (owner) C.u Ma~c,g* sa ~1or,C 5 Lr~ SUBDIVISION M sczE ~alaNc.>r ~s~c`1 LOT # Co3
System Installer: `Tc~ 4~cw~ Registration #
Basement with plumbing: ❑ Garage 'IX Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well MO feet
System Type:- 1 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 CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoA
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~roperty.
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Required: r t
Authorized State Agent 5 Date 3110
This system has been installed in 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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Type of system: El Conventional Other hArnsG2 v.c c_ti1 Septic Tank: ~~od gallons Pump Tank: L000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches J feet ditches
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