OPHTE# -/0 Harnett County Department of Public Health 21 3 0 2
PERMIT Operation Permit
N~f ew Installation e tic Tank ❑ Repair nitrification line 1:1 Expansion
/ PROPERTY LOCATION: vrr,;,- r Q1
Name: (owner) SUBDIVISION f,~~,sL (D,,-k,, LO
System Installer: Wit, ~4-tc-,k Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community CW-~Public ❑ Well Distance from well feet
System Type: 777-(-- 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.
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,piem nos ueen msraneo m compuance wan
North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the
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PERMIT CONDITIONS:
Permit and Construction Authorization.
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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 G~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
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following are the specifications for the sew a disposal s.}stem on the above captioned property.
Type of system: 11 Conventional Other C; Z F1. Septic Tank: gallons Pump Tank: gallons
Subsurface No. of
exact length o width of depth of
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Drainage field ditches o h ditch feet ditches feet ditches 0~,G inches
french Drain Reouired:,~n f inn
Authorized State Agent Date '9
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