OPHTE# Harnett County Department of Public Health 2 0 8 5 9
PERMIT #Operation Permit
New Installation ~9 Septic Tank ❑ Repair-X Nitrification Line ❑ Expansion
PROPERTY LOCATION: Nwy 'ai `
Name: (owner) ~tY. •c.P,N `~o SUBDIVISION _T~Nr-F,, po„~cG LOT # t1 {
System Installer: N40Li-F%rcD Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well CCb0 feet
System Type: --4~-Cr- 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 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 Construction Authorization.
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PERMIT CONDITION-
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
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 abo a captioned property
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Type of system: ❑ Conventional Other c, spsr.C3~CL ~1W,3~ N \b> Septic Tank: \00c!i gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch '75 feet ditches 3 feet ditches I~ inches
French Drain Reauired: _ l inwi font
Authorized State Agent tzCHs Date 4610
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