OPHTE#Q-_, Harnett County Department of Public Health 2 0 5 3 3
PERMIT # Operation Permit
New Installation )E~ Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) O Na c~~5 SUBDIVISION 6 `Ao~) u LOT # 1 __7
System Installer. „w~' C~gx, ~ -z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: `__ff_ Types V and V1 Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nns system nas peen mstauea in compnance wan applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 r>iss ls~E ~s~~c~ ocz~ 3 ~z~~n ~~GUS~ ~s R P~~~~~ Ov L R~~ U3E ~?ti chi~o~3
Following are the specifications for the sewage disposal system on the above capH. oned property.
Type of system: ❑ Conventional Other u mho 11Z v Septic Tank: U gallons Pump Tank: iG0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditthes I ~of each ditch feet ditches feet ditches t inches
French Drain Required:. _~Idnnarlanr~`
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