OPHTE# 01- Harnett County Department of Public Health 19 91 2
PERMIT # ay 3`►1 Operation Permit
New Installation E,4t Septic Tank ❑ Repair 5/ Nitrification line ❑ Expansion
PROPERTY LO(ATION: N a"7
Name: (owner) U-) lV` ear^N, SUBDIVISION
~ LOT
System Installer _A kt Registration #
Basement with plumbing. ❑ Garage 14, Number of Bedrooms
Type of Water 5 ply: ❑ Community Q- Public ❑ Well Distance from well feet
System Type: %A 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.
This system ha been installed in
PERMIT CONDITIONS:
I. Performance:
II. Monitoring.
III. Maintenance:
IV. Operation:
V. Other
with apppliable Mardis Grolina General SUNK AM to Sewage Tremnent and Disposal, and all conditions of the Ins
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Permit and CoMMr-M Author um&
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposals tem on the above captioned property.
Type of system: El Conventional Other ~-'l Size of tank: Septic Tank:
I c> gallons Pump Tank: 1'~ J gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch J feet ditches 3_ feet ditches y inches
French Drain Required: linear feet
Authorized State
Date o " of ~ 0 0
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