OPHTE# 09-aa Harnett County Department of Public Health 21 3 4 8
PERMIT #Operation Permit
New Installation -'P!~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:- `M A~~ 4
Name: (owner) Cu~~ r~>rHNt~ Mss SUBDIVISION Ps",E,5 LOT # 14
System Installer: ~-p buo.,.. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Igo feet
System Type: -xm 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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PERMIT CONDITIONS:
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 system on the above captioned roperty.
Type of system: ❑ Conventional Other
Septic Tank: 10 Od gallons Pump Tank: gallons
Subsurface No. of exact length width of
Drainage field ditches depth of
of each ditch o feet ditches 3 feet ditches IV ~ inches
French Drain Required: rout
Authorized State Agent Date
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