OPHTE# aci -5---1,3 ~3q Harnett County Department of Public Health 21353
PERMIT Operation Permit
New Installation N Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Sys Q o H~
Name: (owner) Q ac_,~~t os~ SUBDIVISION LOT
System Installer: 5 S- r-y-4-A-- r9 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public XCell Distance from well I o ~ feet
System Type: 6"~ 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.
Ihis 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 Consnjtj: @ Authorization
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11 1111 1-ml I I V IIJ.
I. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .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 E Z Septic Tank: to o O gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditche 3 ' of each ditch l (S)O feet ditches 3 feet ditches ) QL, inches
French Drain Required: n wear feet
Authorized State Agent 'X~ ~ MEM5 Date 31A to
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