OPHTE#Qy - S -Z10'7 Harnett County Department of Public Health 2 0 8 9 0
PERMIT # Z 5`q'f5 / Operation Permit
New Installation 9 Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:-" z! o
Name: (owner) CQ Y, SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing. ❑ Garage tuber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 2 5-01zIlV -16Z ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Own must contact Health Department 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with applicable North Carolina General Statutes, Rulessjor Sew'' Treatmer and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with le .1961.
ll. Monitoring: As required by Rule .1961. 2`` J t
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.
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Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~J -1 Z ee ~JI~U~V Septic Tank: ZOO d gallons Pump Tank: 1600 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch /U feet ditches -3 feet ditches O / 8 inches
French Drain Required: linear feet
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