OPHTE# Harnett County Department of Public Health 19902
PERMIT # 2-4 1)1 Operation Permit
)'3-- New Installation J~ Septic Tank ❑ Repair Q~ Nitrification Line ❑ Expansion
PROPERTY LO(ATION: N~ )'I
Name: (owner) SUBDIVISION 1 +H1 Sc-, Q,:, \-c. LOT # 22
System Installer S 41 De -j . Re +istration # ---7 LF~I
Basement with plumbing ❑ Garage $ Number of Bedrooms ~J cc.)r~a
Type of Water Supply: ❑ Community ~p Public ❑ Well Distance from well . S -D feet
System Type: CL 2 E I 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.
Inn srssem naa Deco xtsMM In compMUrce Wrm appnc" R" L="a tKneral NatuK Wks jar Seragt
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Treatment and DisposA and if conditiom of the
Permit and Construction kdtoriUhm
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I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional f Other (a) Size of tank: Septic Tank: _ gallons Pump Tank: gallons
Subsurface No. of c exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches -A-~,! l inches
French Drain Required: , Linear feet
Authorized State Agent 0- Date
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