OPHTE# 1-7-S-T+2.`�3°1 Harnett County Department of Public Health 25060
PERMIT # agi;�.S Operation Permit
New Installation V Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Sq..ac:b64PECL 9-0
Name: (owner) SUBDIVISION LOT #
System Installer. To M My Go t_CY Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community >!� Public ❑ Well Distance from well feet
System Type: T11 Types V and VI Systems expire in S years.
(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 Noah 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other E2 V:IAFW Septic Tank 00 d
gallons Pump Tank gallons
Subsurface
No. of
exact length width of
6
depth of
�'cinches
Drainage Field
ditches
of each ditch feet ditches '3
feet ditches
French Drain Reouired:
Linear feet
Authorized State Agent REh5 Date
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