OPHTE#''~ L Harnett County Department of Public Health 21 18 0
PERMIT # `T' Operation Permit
?,-New Installation L~_ Septic Tank ❑ Repaid Nitrification Line ❑ Expansion
PROPERTY LOCATION: IV C
Name: (owner) /A , s SUBDIVISION % rv r e, LOT # ~f
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5~
Type of Water Supply: ❑ Community SZ' Public ❑ Well Distance from well C
feet
System Type: Q, . . I t'~ t-I C L, - ' i L-IT Q 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
4-1 with applicable North Carolina General Statutes, Rules for
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Treatment and Disposal, and all conditions of the
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I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Permit and Construction Authorization.
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following are the specifications for the sewage disposal syss.em on the above captioned property
Type of system: El Conventional i~T Other `J,-. tz H C `sue~M Septic Tank: ? t gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of ,
Drainage Field ditches of each ditch feet ditches
French Drain Required: feet ditches ( inches
Linear feet
Authorized State Agent Date
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