OPHTE# t~""~° 'O Harnett County Department of Public Health
PERMIT Operation Permit 2 2 3 4 0
1 New Installation ~ Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Q,-1 .Gs5 G v . 'ZD
Name: (owner) SUBDIVISION C.jgQ-Q,65 0 "1-f C LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage '19~ Number of Bedrooms
Type of Water Supply: ❑ Community '4 Public ❑ Well Distance from well t 00 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.
inns system nas seen mstanea in compuance w¢n appucaoie norm Lamina uenerai xatutes, NO for sewage ireatmen[ ana uisposai, ana an conainons of me improvement rermt ana construction Numorization.
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PERMIT CONDITIONS:
1. Performance:
IL Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ 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 CZ ~LU'v tr Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch CC> feet ditches feet ditches inches
French Drain Required:
Authorized State Ag:!!_!,~ - QeS Date t
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