OPHTE# �� �5"/ Harnett County Department of Public Health 23241
Z_ -75 Y Operation Permit
PERMIT # o
New Installation C�Septic Tank f�Nitrification Line ❑ Repair ❑Expansion
PROPERTY LOCATION: c�'� "LOT #
Name: (owner) � %�
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SUBDIVISION LOT #
System Installer: 61+;f Registration #
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Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community ❑ Public 2'- Well Distance from well 160 feet
Types V and VI Systems expire in 5 years.
System Type: Owner must contact Health Department 6 months prior to expiration for permit renewal.
(In accordance with Table V a)
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:
1. 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:
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V. Other: Alarm H2OLine El PWR Line
C-1 D -Box ❑
Pump ❑ ❑
Following are the specifications for the sewa disposal system on the above captioned property. Septic Tank: 1 g allons Pump Cc p Tank: gallons
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Type of system: El Conventional Other f—f width of depth of
Subsurface No. of exact length S ditches " inches
Drainage Field ditches of each ditch
feet � feet ditches �
French Drain Required: Linear feet
/� Date ���2"
orized State Agents /.--�� ` ""' le
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