OPHTE# Harnett County Department of Public Health 21 4 6 3
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line El Expansion
PROPERTY LOCATION:_ =,o N
Name: (owner) P,,-L CIL o ttr - ' ~o c-, 5 SUBDIVISION PCB. p LOT #
System Installer: LKRR~j Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ICAO feet
System Type: ~-=0, 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 CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
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 XOther I IcZE C-)A PS Septic Tank: k000
Subsurface No. of gallons Pump tank: gallons
exact length width of depth of
Drainage Field ditches of each ditch S feet ditches
a0-30 French Drain Required: feet ditches _ _ inches
Authorized State Agent 2 ~ "~Z S Date 5U10
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