OPHTE# b-~JJ - a g-Z Harnett County Department of Public Health 2 0 5 2 0
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repairj' Nitrification Line ❑ Expansion
PROPERTY LOCATION:*
Name: (owner) 00C l,Je f f lkm e , 5 UIRDIffilON ~ ' : - V n , . I AT 4
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System Installer. _ f ) 1,r,-t Ir 1 ( Registration #
Basement with plumbing: ❑ Garage 1K- Number of Bedrooms _3
Type of Water Sup ly: ❑ Community Eye Public ❑ Well Distance from well feet
System Type: • 7 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ow er must contact Health Department 6 months prior to expiration for permit renewal.
[his 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 conditions, maintenance and reporting
following are the specifications for the sew a disposal syst on the above captioned property.
Type of system: ❑ Conventional Other 2 fr 1 V Septic Tank: 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch ~j feet ditches- feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date
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