OPHTE# - ,6 Harnett County Department of Public Health
PERMIT # .Operation Per ' 2 2 2 8 5
I2' New Installation Cc Tank 01- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ,--1 'Ili
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: El Garageumber of Bedrooms _5
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: 75!'/a :&vs .774 Cam, !~S Types V and VI Systems expire in 5 years.
(In accordance with Table V a) if / Owner must contact Health Department 6 months Xior to expiration for permit renewal.
This system has been installed in compliance with aaalicable North Carolina Genezal.itewes. Rules for Sewage Treatment and
Permit and Construction Authorization.
French Drain Required: Linear feet
Authorized State A nt Date°
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