OPHTE# N 30 - 1-U5 5 > Harnett County Department of Public Health 2 0 6 4 7
PERMIT # R~ 6 'S 1 Operation Permit
CE - New Installation Septic Tank ❑ Repair ' Nitrification Line ❑ Expansion
PROPERTY LOCATION: 117 F
Name: (owner) SUBDIVISION (~5 (2e 3-7 D n K J LOT # (
System Installer. Registration #
Basement with plumbing: ❑ Garage Y Number of Bedrooms _~0 q
Type of Water Supply: ❑ Community E4-^ Public ❑ Well Distance from well feet
System Type: C , 2 r loy 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.
ims system nos Deen 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: 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 disposals stem on the above captioned property.
Type of system: ❑ Conventional `J~1' Other 1 17\0\J Septic Tank: Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _2_ feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent 1 Date - '
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