OPHTE# 1D-5°0- a~i yap{ Harnett County Department of Public Health 21392
PERMIT # 2.S9 -7 Operation Permit
~c~► ~ ~ MISSt( New Installation t- Septic Tank El RepaitZ Nitrification Line ❑ Expansion
td~ rl ut j PROPERTY LOCATION: ~:~33
Name: (owner) (za") SUBDIVISION C4-Av~,' LOT #
System Installer: 2- ~ t Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 4,~Z Public ❑ Well Distance from well feet
System Type: w~~• n -t4 r
? zt.r 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.
ims 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: 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 dispos system on the above captioned property
.
Type of system: ❑ Conventional ❑ Other s f~~ (-/"'n ~.It Septic Tank: ODD gallons Pump Tank: 000 Subsurface No. of gallons
exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches
inches
French Drain Required: Linear feet
Authorized State Agent Date '
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