OPHTE# /n-~ --Z3 5-M Harnett County Department of Public Health 21 0 4 7
PERMIT # L 571 7 Operation Permit
dNew Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:.SP/m(Co6d
Name: (owner) ZA-J4)1-Ya2~►,v~,t/ So SUBDIVISION LOT #
System Installer. &f / Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community r public ❑Wee j Distance from well feet
System Type: okra Types V and VI Systems expire in 5 years.
(In accordance with Table V a)-e-i3.r 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:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and
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Following are the rclonventional cations for the sewage disposal system on the above captioned property
Type of system: ❑ Other
Subsurface No. of exact length
Drainage Field ditches C-11 of each ditch feet
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Septic Tank: /CiW gallons Pump Tank: / gallons
width of depth of
ditches ~ feet ditches &Y inches
trench Drain Required: Linear feet
Authorized State ent f~ Date g 4" /0
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