OPHTE# ~a-E x'050 Harnett County Department of Public Health
PERMIT # 'A6~ 19 Operation Permit 2 2 31 0
New Installation K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) vst~ ~~~Ea 1c SUBDIVISION ~~~s\, Qoo~~~G LOT #\-1?>9
System Installer: _ 0715 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Commum Public ❑ Well Distance from well f o0 feet
System Type: Lt _ 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.
[his 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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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 ❑ NOXl
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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ V-7i~ow Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch $ d feet ditches 3 feet ditches 11 "3 ® inches
French Drain Required: -1, t
Authorized State Agent ~\\\\U`~\ UN-.> Date
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