OPHTE# P--- -a } Harnett County Department of Public Health
PERMIT Operation Permit 2 2 4 2 7
New Installation K Septic Tank K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 04U NL--~ CZZ
Name: (owner) NASL 5r70 R N ~-S=Tf SUBDIVISION So, LOT # 2k.
System Installer: $ ~APQQ `i- Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms .2;>
Type of Water Supply: ❑ Community ❑ Public Well Distance from well t 0 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
rtKMII t,unulIIUNS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E--Z- F L.O W Septic Tank: N 00 d gallons Pump Tank:
Subsurface No. o exact length width of depth of _
Drainage Field ditches ` of each ditch to feet ditches feet ditches
French Drain Reauired: ek, ®°~lt eet
PWR Line
gallons
inches
Authorized State Agent , Date It 6't 110, Rjvw
7 S yj. z n
~~S 31
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