OPHTE#Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 3 2 3
New Installation 'K Septic Tank ;g1 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: MP,2~5
Name: (owner) -yonc3tCL vU ~Oce,FS INC- SUBDIVISION ~s~E~oaS~ LOT #
System Installer: 5~>cuo-,r( Registration #
Basement with plumbing: ❑ Garage "K Number of Bedrooms
Type of Water Supply: ❑ Community -;N( Public ❑ Well Distance from well S O O 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.
111. 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 ❑ _
Following are the specifications for the sewage disposal stem on the above captioned operty.
Type of system: ❑ Conventional X Other r_1% GQ_ / ~ASeptic Tank:
Subsurface Noof exact length width of
Drainage Field ditche of each ditch ~"Da feet ditches _
French Drain Reaeixe . 14 r feet
H2OLine ❑
PWR Line
S d Ci gallons Pump Tank: gallons
depth of
feet ditches inches
Authorized State Agent RC'1~51 Date 51,2`11
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