OPHTE# 1a J a- �'1O�Ij Harnett County Department of Public Health
PERMIT # ®6® Operation Permit 22505
New Installation X Septic Tank �e Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'Mr�szx�
Name: (owner) CVtn4%?_LPsNfl >~ >o�nE 1rvc. SUBDIVISION N5'N c=ow LOT # 1-5
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well 1 C) O feet
System Type: i T 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.
finis system nas oeen inszauea in
wim appucanie norm tarmma uenerat statutes, Rules for )ewage treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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: U "r%9
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned props
Type of system: ❑ Conventional �_Xr Other P U r3 p 1 Q QA Septic Tank: \ 0 00 gallons Pump Tank: i C50 d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches-°—)L-- _ of each ditch 1 5o feet ditches feet ditches 'a4�'34 inches
French Drain Reouired: -.feet
Authorized State Agent , `"' ~4`. " Date
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