OPHTE# ,a- Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 0 4
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: MLA, ~
Name: (owner) Qrnhe ~..->c> \)ioMc5 ~10cr SUBDIVISION PNcaszp LOT # 2>
System Installer: i S Registration #
Basement with plumbing: ❑ GarageI Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well `®C> 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 ❑ H20Line ❑ PWR Line
Following are the specifications for
the sewage disposal system on the abovg captioned,
property.
Type of system: ❑ Conventional
X Other CN4~rn+br:f~-
Septic Tank: 1i OHO gallons Pump Tank: gallons
Subsurface No. of
exact length
width of depth of
Drainage Field ditches
, of each ditch
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feet ditches feet ditches- inches
French Drain Required: \
wear
Authorized State Agent \ 746 Date 111
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