OPHTE# 10-5 a5all Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 0 7
New Installation )i4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Po N~.a~5~ ~a
Name: (owner) C.., to 0 P"C=5 SUBDIVISION Ga~a oi.~ N s~ 5~Q~a s LOT #
System Installer: " 1c o 19.oet-j Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communityy Public ❑ Well Distance from well tU® feet
System Type: Types V and VI Systems expire in 5 years.
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(In accordance with Table V a) 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: 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 Z
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above capti°ed property.
Type of system: ❑ Conventional IK Other CF►Pcc*e~C~t (WA.1 Septic Tank: li C00
Subsurface No. of exact length width of
Drainage Field ditches 1 of each ditch 1'10 feet ditches 3
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
French Drain Required: ear feet
Authorized State Agent ~\`~s Date a a
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