OPHTE# i� �s���a s Harnett County Department of Public Health 23080
PERMIT # 02! y y Operation Permit
ET' New Installation Septic Tank ErNitriCication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: bG�J .ed-
Name: (owner) /L Cc.1f14-u C;/- �o SUBDIVISION LOT # (
System Installer: 7-A01 AunJ- p /ter -�.`n4 Registration #
Basement with plumbing: El Garage El Number of Bedrooms "'I
Type of Water Supply: ❑ Community 13�Public ❑ Well Distance from well feet
System Type: �ZG° 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.
[his 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch NO feet ditches 3 feet ditches %cS ' inches
French Drain Required: Linear feet
Authorized State Agent4i," .-_ �w� 4e Date _ / 2 /d 7 /2 a1.7
72 a-1-5-