OPHTE# alas( Harnett County Department of Public Health 2 0 6 4 3
PERMIT # QS- d k Operation Permit
New Installation c. Septic Tank ❑ Repair& Nitrification Line ❑ Expansion
PROPERTY LOCATION: j `~f
Name: (owner) 2/~ c If u c A S SUBDIVISION Lr/I e-1 . C LOT # 16 l
System Installer: (e Registration #
Basement with plumbing: ❑ Garage 5~, Number of Bedrooms
Type of Water Su❑ Community IF Public ❑ Well Distance from well 3, feet
System Type: ~--(y. • C(/[ `^t INN J 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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DCDMIT rAMAITInu[.
1. Performance:
11. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. 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 ge disposal sy on the above captioned property.
Type of system: ❑ Conventional [ Other ck Septic Tank: 10P gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ` TLS? feet ditches- feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 2-
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