OPHTE# Harnett County Department of Public Health 21 5 0 5
PERMIT # Operation Permit
New Installation ~K Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: N G'~7
Name: (owner) Cv mSrJt- ~I~ pn.Fs SUBDIVISION M \a.E 45a.p,t4oN LOT # 6_
System Installer: 7-0 8CLt w r-4 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S 6 feet
System Type: ~a 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.
[his 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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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 disposal system on the above captioned i perty.
Type of system: ❑ Conventional Other GAN-,0 ~t, Septic Tank: yad gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditchS feet ditches feet ditches aL!- inches
French Drain Required: Linear4pt
Authorized State Agent Q
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