OPHTE# IC7-5-DL3 1-5 LA Harnett county Department of Public Health 21 4 8 2
PERMIT # 1s~~`dU Operation Permit
New Installation K Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Name: (owner) ~,,.,r-,y ws~z=-~ SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
inn system Pas peen mstanea 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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DCDMIT rnunITIAIIC
1. 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 above captioned property.
Type of system: ' Conventional El Other
Subsurface No. of exact length
Drainage field ditches 3 of each ditch 1 -23 feet
French Drain Required: faP~
Septic Tank: Id CC) gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches a9 inches
Authorized State Agent V N" y Date GI-11 )6
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