OPHTE# ~0-5--a33 Harnett County Department of Public Health 21 3 6 6
PERMIT # a5~~ Operation Permit
New Installation Se tic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) E, P. ~ao~2E~ SUBDIVISION 'Ea LOT #
System Installer: ---T!Ey-cL j A~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public '~k Well Distance from well lOG feet
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System Type: 7:UL5q 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.
finis system nas peen mstauea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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Permit and Construction Authorization.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nov
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 prop
Type of system: ❑ Conventional Other kA Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch 0 feet ditches _
French Drain Required: Linear fe~t~
and all conditions of the
EX~ss \^sG
t+s(1 mc.
teo O gallons Pump Tank: gallons
3 depth of
feet ditches %3 inches
Authorized State Agent 9 ~5 Date 4) 11S 6
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