OPHTE# ?o5- L Harnett County Department of Public Health 2 0 4 9 9
PERMIT # Operation Permit
-New InstallatiolpQ Septic Tank ❑ Repait'Q~ Nitrification Line ❑ Expansion
PROPERTY LOCATIO ~
Name: (owner) NA, a~ ~ SUBDIVISION ! LOT # 4
System Installer --c U^ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supp ❑ Community Public ❑ Well Distance from well 1 feet
System Type: 1(I Ty (Jt, c t': W 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.
This system has been installed in
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with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Improvement Permit and Construction Authorization.
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Following are the specifications for the sewa a disposal tem on theabove ptioned property.
Type of system: ❑ Conventional ] Other !4 ' I~ `f Septic Tank: J J gallons Pump Tank: 330 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches , of each ditch J feet ditches- feet ditches-) 9, d 4 inches
French Drain Required: Linear feet
Authorized State Agent ~ ~ Date k ' )
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