OPHTE#Harnett County Department of Public Health 21 3 8 5
PERMIT #Operation Permit
ew Installationi Septic Tank ❑ Repai~_ Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1 1
Name: (owner) SUBDIVISION LOT #
System Installer: r _ IN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ;9~,Public ❑ Well Distance from well Py feet
System Type: C.A n C~sr 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.
nm sprem nas been mstaieb in compnai
J
ANT
wnn applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the
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.
Ill. 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 a disposals, stem on the above captioned property.
Type of system: ❑ Conventional Other t~C._,+- OX 'A ( itA jtf Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch feet ditches 3_ feet ditches inrhes
French Drain Required: linear feet
Authorized State Agent` `'l Date