OPHTE# ~ "~D~ Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 31 5
New Installation`~X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: GyF'a Ess C-"\jg.Q~ '~Z
Name: (owner) SUBDIVISION Cy19<LC-. 511 Vol _ ti.. LOT #
System Installer: Z _v-6 -n Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 C7 feet
System Type: ~ 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.
11. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noy<
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 s stem on the above captioned property.
Type of system: ❑ Conventional Other 'Z.'V:L_0W Septic Tank:
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length width of
ditches 6 of each ditch a4® feet ditches 3
depth of
feet ditches inches
French Drain Reauired:
-,6,tar few
Authorized State Agent ~ Q.0AS Date _E0_02__
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