OPHTE# 0-1 aa~„3 Harnett County Department of Public Heath
PERMIT # 5 63g Operation Permit
New Installation 19, Septic Tank ~ Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION:
Name: (owner) ~N'Ii>C- c. SUBDIVISION K u F LOT # --S L-4-
System Installer: ~l ii,-j ~ cs HAS Registration #
Basement with plumbing: ❑ Garage -.'2~ Number of Bedrooms __3_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tC)C~) feet
System Type: G" 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.
finis 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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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 cc
itions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the ab(o~ve, captioned perty.
Type of system: ❑ Conventional ~3( Other C ~rnF3C~l l v c c ~ Septic Tank: d O Qj' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch I b feet ditches 311 feet ditches inches
French Drain Reauired _ nr %t
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