OPHTE# DIdG'-1 Harnett County Department of Public Health 2 0 51 9
PERMIT # Operation Permit
°New Installati Septic Tank ❑ Repairo Nitrification Line ❑ Expansion
PROPERTY LOCATIO : b L P \ j
Name: (owner) Ca^~~, SUBDIVISION l ,j ~h-' -S" LOT #
System Installer: 't Q (z,3 Registration #
Basement with plumbing. ❑ Garage -,iC Number of Bedrooms 73
Type of Water Sul ❑ Community 42~ Public ❑ Well Distance from well J feet
System Type: L< t~ ✓ 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 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:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ N1.4
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other
Following are the specifications for the sewage disposal s m on the above captioned property.
Type of system: ❑ Conventional )1~1 Others, c (c Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of J
Drainage Field ditches of each ditch Q O feet ditches 3 feet ditches O inches
hrench Drain Required: linear feet
Authorized State Agent Date - - ~)CA
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