OPHTE# 1 -11�-- 5 07) Harnett County Department of Public Health 23144
PERMIT # a.�1 �3 0 eration Permit
New Installation eK Septic Tank )5< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: DGEO
Name: (owner) pchc5 SUBDIVISION '�Ir�- ►or,P,s �'lar�o� LOT #
System Installer: L� s irc.x -o-9 Registration #
Basement with plumbing: ❑ Garage 'S� Number of Bedrooms
Type of Water Supply: ❑ Community '' Public El Well Distance from well 1®Q7 feet
System Type: 1-n 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.
ims system nas peen inscanea in compuance wim appicame norm Lamina uenerai macuces, rues for sewage ireacmenc ana uisposai, ana au conamons or me
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: L1 Conventional � Other F--Z— KL or ,
Subsurface No. of exact length
Drainage Field ditches of each ditch 75 feet
Alarm ❑
rermic ana sonscruamn aumonzanon.
H20Line ❑
PWR Line
Septic Tank: t coo gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 1�"�� inches
French Drain Required: — Li nar, feet
Authorized State Agent �`��� 15 Date
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