OPHTE# I-5 Harnett County Department of Public Health 21 4 7 2
PERMIT # ~1 S~ Operation Permit
ti~- New Installation ~ Septic Tank ❑ Repair 7~-Nitrification Line ❑ Expansion
PROPERTY LOCATION: LA 01
Name: (owner) ~^9 } SUBDIVISION H.\\ LOT # vA
System Installer ks Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community )~I, Public ❑ Well Distance from well feet
System Type: Cr Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mus contact Health Department 6 months prior to expiration for permit renewal.
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: ❑ Conventional Other2C L
H-10 cl„lx- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches- of each ditch- feet ditches 3 feet ditches- inches
French Drain Required: Linear feet
Authorized State Agent J
e Date
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