OPHTE#0 ~ - 00- 52 ~3)9 Harnett County Department of Public Health 20731
PERMIT # Operation Permit
-New Installation (IY- Septic Tank ❑ Repair,' Nitrification Line ❑ Expansion
PROPERTY LOCATION: k 1
Name: (owner) '9- SUBDIVISION `ve) A < LOT # I IV
System Installer: U - ~i( (1, t c~ Registration #
Basement with plumbing: ❑ Garage -i~V Number of Bedrooms
Type of Water Supply: E~. Community -,;Z Public ❑ Well Distance from well feet
System Type: J L./Sp 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 nas oeen installed in
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A
IT CnNNTIAW-
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
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 sews disposal syste on the ove captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of 1 exact length width of depth of ~y
Drainage field ditches t of each ditch 3 feet ditches- feet ditches O inches
french Drain Required: Linear feet
Authorized State Agent Date _ 0 ~ - I ~ ' 3
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