OPHTE# Q- 5-Q.-6 15Lj Harnett County Department of Public Health
PERMIT # -2 cf0 Operation Permit 2 2 3 4 5
X New Installation 'a Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Q 5c -s
Name: (owner) \c4 y~,~ oN SUBDIVISION -7r0-,-)F-Q5 V-,oGt- LOT #
System Installer: KvrcT;- QL-v r- 5)t) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 da feet
System Type: -L~~_ 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 plicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1Aouv. W~~SR 2.t.s
FHMII LUNUIIIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
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 s stem on a above captioned property.
Type of system: ❑ Conventional Other Z1-0 ! Septic Tank: i ®Q 0
Subsurface No. of exact length width of
Drainage Field itc ed es of each ditch 2 Od feet ditches 3
French Drain Reauimd- ~
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
Authorized State Agent Date
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