OPHTE# '~51S Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 0 2
New Installation ~K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC.I
Name: (owner) G~•~-~' )'A60 s )AOME S SUBDIVISION G wG j ® `C.s LOT #
System Installer: 01-,s SnQ-,e--,5-L ^P Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms
Type of Water Supply: ❑ Community _;9, Public ❑ Well Distance from well 100 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.
Ihls system has been installed in compliance with apphcame north larohna beneral )tatutes, fines for )ewage Treatment and
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and an conditions of me improvement rerm¢ and Lonstrucnon numonzadon.
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PERMIT CONDITIONS:
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 ❑ No
IV. Operation:
V. Other:
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 s stem on the above captioned property.
Type of system: ❑ Conventional Other Z- ~LCIW Septic Tank: 1 p 0 0 gallons Pump Tank: 1 CEO ~ gallons
Subsurface No. of exact length width of depth of ~
Drainage Field ditches of each ditch feet ditches feet ditches Iinches
French Drain Reauired: Cti'k,~
Authorized State Agent -~'`5 Date rc,
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