OPHTE#-j A ,113-7 Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 0 7
New Installation k Septic Tank 4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NAyj4 `6 -1
Name: (owner) SUBDIVISION ~ ~a > C LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 5 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:
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 ❑ NoX
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D-Box ❑
Following are the specifications for the sewage disposal
Type of system: ❑ Conventional Other
Subsurface No. of
Drainage Field ditches
French Drain Reouired:-.~ '`edn(
_ Pump ❑
stem on the above captioned property.
'Z. ' i. W
exact length
of each ditch I S- feet
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: O b d gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent Date 14,411 `
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