OPHTE# //-.s- a_7 60 Harnett County Department of Public Health
2 2 0 3 9
PERMIT # K - /Operation Permit
Q New Installation LEf Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: / 9 / Z dl ,jnLv~Xd-
Name: (owner) 4 4-Ps 3y 4-1 SUBDIVISION /f C- t ~r F-z~• LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public d Well Distance from well / U Q~ feet
System Type: z5E__, G- 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.
Ihls system has been installed in
1-1-)12-`` CA_
with applicable north Laratma beneral )tatutes, Rules for )ewage treatment and usposal, and all conditions of me improvement rermlt and Lonstructton Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No F~f
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew)e disposastem on t e above captioned property.
Type of system: El Conventional Other - . ' /j Septic Tank: / 130 ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch feet ditches feet ditches- inches
French Drain Required: Linear feet
/ Z, /1" Authorized State Agent a-, Date /l //y
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