OPHTE# / X- ?'-00 Harnett County Department of Public Health
PERMIT # a-~- 88 q Operation Permit 2 21 9 3
k2r New Installation ER" Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: JG~f/l~
Name: (owner) SUBDIVISION C -k ~ LOT # q
System Installer: Ott .1 ffr - k i.,q Registration #
Basement with plumbing: ❑ Garage Er' Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Zr- 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.
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PERMIT rr)NnITIM-
wim appucame north Larouna benerat statutes, Wes for sewage treatment ana msposai, ana an conanions of the improvement Permit and Construction Authorization.
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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 ❑ No
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 sewadisposal system on the above captioned property.
Type of system: ❑ Conventional {J Other /:-;7 Z ))Z t--3 Septic Tank: Z"o-C) gallons Pump Ta& gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3C) C, feet ditches feet ditches J0 inches
French Drain Required: Linear feet 1
Authorized State Agen IlZrIJ Date =2-V tl1~
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