OPHTE# io~s-a~~z,u Harnett County Department of Public Health 2 0 8 6 2
PERMIT # Operation Permit
New Installation 'U Septic Tank 1:1 Repair Nitrification Line El Expansion
PROPERTY LOCATION: Nwy
Name: (owner) SUBDIVISION
LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage' Number of Bedrooms
Type of Water Supply: ❑ Community . Public ❑ Well Distance from well ) DO feet
System Type: 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.
im> iptem nas peen Instanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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VFRMIT rANnITIAM(
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I. 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 ❑ No
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 ab ve captioned prope
Type of system: El Conventional Other P.r.4E~L ~A2L 3~ Fa~bt., Septic Tank: t OOU gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch "7~ feet ditches 3 feet ditches as inches
French Drain Required: CI feet
Authorized State Agent N'A ~~~`~\9-ev~5 Date H 10