OPHTE# Harnett County Department of Public Health 21 0 2 5
PERMIT # 2Vq& Operation Permit
5~ New Installation Septic Tank ❑ Repair c~ Nitrification Line ❑ Exnansinn
PROPERTY LOCATION: SIL/5/No -j~ 4oKz4,:;
Name: (owner) . o nil pcoe4 ones SUBDIVISION 70r,jV4 LOT # -/7_
System Installer: Registration #
Basement with plumbing: ❑ Garage / Number of Bedrooms -3
Type of Water Supply: ❑ Community C~ Public ❑ Well Distance from well feet
System Type: 7 % 4!~b1t7Z46>j Types V and YI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
.ms system nas peen mstanea in compliance with
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North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
1. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional ZOther ZSeYb-IZe74~t)cTLe-~,- Septic Tank: / U a 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch 1 w feet ditches 3 feet ditches 2 y inches
trench Drain Required: Linear feet
Authorized State Ag Date y` 1 9- to
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