OPHTE# c-7 - 5-- /C -1 V2 Harnett County Department of Public Health 21 1 5 2
PERMIT # :l r -2 7 /
Name: (owner) l4o,-,adC Aww-k r
System Installer: G t-{- : r J-+- tc ( d
Basement with plumbing: ❑ Garage 2"'Number of Bedrooms
Type of Water Supply: ❑ Community Q"'Public ❑ Well
System Type: 11 Q:
(In accordance with Table V a)
Operation Permit
"New Installation VSeptic Tank ❑ Repair 1~61triffcation line ❑ Expansion
PROPERTY LOCATION: 1-4.,-.;,mot Cd
SUBDIVISION Gg - ~'j rf LOT # I6
Registration #
Distance from well feet
Types V and VI Systems expire in 5 years.
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 Trgatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Z'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. r nh nr4r CU~~t 2. Alp --4 • zr'
Following are the specifications for the sews disposals stem on the above captioned property.
Type of system: ❑ Conventional Other E2 Ft-,,J Septic Tank: /W ` gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Oro feet ditches ~ feet ditches inches
French Drain Reauired: . , -~-linpate-4"t
Authorized State Agent 'XINI-4 Date r
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