OPHTE# Q 9-~~-y~- Harnett County Department of Public Health 2 0 6 4 4
PERMIT # Operation Permit
~ ew Installation C -Septic Tank ❑ Repair F ~litrification Line ❑ Expansion
PROPERTY LOCATION: I 115
Name: (owner) SUBDIVISION rf) f-21 -'M LOT #
System Installer z f c Registration #
Basement with plumbing: ❑ Garage ')Z--Number of Bedrooms oNn
Type of Water Sup I : ❑ Community Q~' Public ❑ Well Distance from well L2 feet
System Type: - 7 C7 I J t / T-IM 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.
[his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sew a Treatment and Disposal, and all conditions hmprovement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
II. 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:
Following are the specifications for the sewage disposal s m on the above captioned property.
Type of system: ❑ Conventional g Other lr,- 4'-- \~i / Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch v-7 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 1
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