OPHTE# 1,—;).- 5- a430d Harnett County Department of Public Health
PERMIT # ��10�1 Operation Permit 22521
New Installation )l Septic Tank b< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: hlo-L Luc K-, Qp
Name: (owner) 1a>y-,yAAA �110mE5 iIPSI G SUBDIVISION Tos H �xo "W�-Z\m4 LOT #
System Installer: <'c)s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 2,
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1013 feet
System Type: 7=L 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 l.arolma Ueneral )tatutes, Roves [or )ewage treatment and
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and all Conditions of the Improvement rernut and l.onstruction Authorization.
PERMIT CONDITIONS:
I. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z S-Lo,,
Subsurface No. of exact length
Drainage Field ditc es ` of each ditch feet
French Drain Reouired: — A `���kear feet
Alarm ❑ 112O1-ine ❑
PWR Line
Septic Tank: *0 C/ gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 1*? '3 0 inches
Authorized State Agent Date
I -- 5- --.\q 3 0 Ca