OPHTE# (?)-5 �� �'1 Harnett County Department of Public Health 23155
PERMIT #- �r'i�® Operation Permit
New Ins tallation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:
Name: (owner) -ysr—�cu,) .-«osy SUBDIVISION Q LOT # dB<Z
System Installer: Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms LJ
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well _1,C)2 feet
System Type: t y 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.
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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:
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned o erty.
Type of system: ❑ Conventional Other _ a r`�' — 2. \,f Se tic Tank: VOOO
YP Y _ • p gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditcTes — of each ditch 9--) o feet ditches - feet ditches 1�
French Drain Required: �� _ r feet
Authorized State Agent Date ->,I 1! I I
PWR Line
gallons
inches
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