OPHTE# 1Harnett County Department of Public Health
PERMIT # a~'~`1® Operation Permit 2 2 3 2 5
New Installation Xl Septic Tank .~Nitrification Line El Repair El Expansion
PROPERTY LOCATION: SK,,.r G~s C.~
Name: (owner) ~A vc-N y tu.ES (i6 vN1~OE;cLS SUBDIVISION \~At,raV ctc,v E LOT #
System Installer: 071.5 C-~ s21Cr`4-LP.ntS3 Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well VnIZ) feet
System Type: ="1k 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.
Ims 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 ❑ NVINN
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 captio d property.
Type of system: ❑ Conventional Other 1 V rnQ ) 6 F_ "O%-i Septic Tank: 100 0 gallons Pump Tank: 034 gallons
Subsurface No. of exact length width of depth of
Drainage Field es 3 of each ditch 0 feet ditches 3 feet ditches A 361 inches
French Drain Reauir4.z~ feet
Authorized State Agent Date 51a0dIZ.,
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