OPHTE# }off'-a~~~ Harnett County Department of Public Health
PERMIT # ~M Operation Permit 2 2 4 3 3
New Installation "I~?, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \J %4r,,
Name: (owner) Spw j I \Abn s W_ C_ SUBDIVISION 1~N~,,p,,,I LOT # 15
System Installer: H~.czD~~ ~ER-~ 1G. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S®O 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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113.
1. Performance:
II. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
D-Box
❑ Pump ❑
Alarm ❑ H20Line ❑ PWR Line
following are the spec
ifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
~ Other C`Z-FLrs J
Septic Tank: 1.50 gallons Pump Tank: gallons
Subsurface
No.
exact length
width of depth of
Drainage Field
ditches
_ o ch ditch ® feet
ditches feet ditches 30 1q inches
French Drain Reouired:
_
-fin' P-nlr ac
Authorized State Agent Date
75
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