OPHTE# 10-.S - ~y' ~ Harnett County Department of Public Health 21 3 7 4
PERMIT # t Operation Permit
I New Installation -JZ-Se tic Tank ❑ Repai itrifcation line ❑ Expansion
PROPERTY LOCATION: A`\t L
Name: (owner) AN ~ SUBDIVISION L~fy- 5cr-Q LOT #
System Installer: _&M ~ T Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community _t Public ❑ Well Distance from well feet
System Type: _ f3 11 ,mot 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 Carolinal. - , for Sew3gq Treatment and Disposal, and all conditions of the Improvement Permit and Construction Auth t
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961. C'
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 4
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 ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch AD feet
French Drain Required: Linear feet
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Septic Tank: 1 CN~o 6 gallons Pump Tank: gallons
width of depth of
ditches feet ditches- inches
Authorized State Agent ~ Date
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