OPHTE# 10Harnett County Department of Public Health 21 31 2
PERMIT # Operation Permit
New Installation 2--S ptic Tank ❑ Repair ENitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION m----F.,J LOT # /ld
System Instal ler. T ~r 1 Registration #
Basement with plumbing: ❑ Garage ❑--Number of edrooms 2
Type of Water Supply: ❑ Community 2""Fublic ❑ Well Distance from well feet
System Type: ; ~s- 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:
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f ertormance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No FIK
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewageAsposal system on the above captioned property.
Type of system: El Conventional C~ Ot
her f% 2 A16,,.>
Septic Tank: /04)4
gallons Pump Tank: gallons
Subsurface No. of
Drainage Field ditches
exact length
of each ditch feet
width of
ditches -3
depth of
feet ditches inches
French Drain Required:
Linear feet
Authorized State Agen _
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Date
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