OPHTE# Da `50~-PX3s Harnett County Department of Public Health 21 3 7 2
PERMIT # Operation Permit
New Installation ; - Septic Tank ❑ Repair *Q Nitrification Line ❑ Expansion
~M~`~ PROPERTY LQCATIQtW Y1 C ~
Name: (owner) SUBDIVISION ~ Q 2~r•cL. LOT #
System Installer: `7. Q Registration #
Basement with plumbing: ❑ Garage f9l( Number of Bedrooms
Type of Water SuDDI : ❑ Community C~ Public ❑ Well Distance from well feet
System Type: UC%-- .ch, 'C~j/ 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.
ino )rxem nos ueen msianea in compliance wan applicable north Carolina General Statutes, Rules for
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PERMIT CONDITIONS:
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Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nog;
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 property.
Type of system: ❑ Conventional 16 Other s t ~ k LA Septic Tank: ?~2 gallons Pump Tank: gallons
Subsurface No. of exact length r~ width of depth of
Drainage field ditches of each ditch tip feet ditches _3_ feet ditches inches
French Drain Required: linear feet
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Authorized State Agent ( Date ~ -
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