OPHTE# i3 -5= 1D�3--7 Harnett County Department of Public Health
PERMIT # ��� Operation Permit 22894
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Does
Name: (owner) c, C-E -� SUBDIVISION AU-mo LOT # '-�LS
System Installer: Fo Q 1 E. C' Registration #
Basement with plumbing: ❑ Garage' Number of Bedrooms
Type of Water Supply: ❑ Comm Public ❑ Well Distance from well feet
System Type: , 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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I. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned probe ®rty. i
Type of system: ❑ Conventional , K Other iP y m� '7o pct+ 621QT°�� Septic Tank:
Subsurface No. of exact length width of
Drainage Field-- _dititchess of each ditch feet ditches
French Drain Required, — Linear feet
H2OLine ❑
PWR Line
gallons Pump Tank: T®®o gallons
depth of
feet ditches inches
Authorized State Agent C-C-4\5 Date 1y113` 1
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