OPHTE# 1 Harnett County Department of Public Health 21 4 9 8
PERMIT # ty Operation Permit
New Installation 71~1. Septic Tank ❑ RepairX Nitrificati Line ❑ Expansion
PROPERTY LOCATION: oJC,3`l~f Ck-'N66~tV 1--rv
Name: (owner) E-p-,g ~nc5 00,(2~,q 6) SUBDIVISION ~~tva~tBU21L LOT # ` TLS
System Installer. 76(D Registration #
Basement with plumbing ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well K!0 feet
System Type: U-3- 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.
ins system nas peen ms[anea in
With
pncable North larobna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. 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.
Following are the specifications for the sewage disposal system on the above captioned pr rty.
Type of system: ❑ Conventional Other C *~AchcvF - Q o . of Septic Tank: l (500 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches - of each ditch )(50 feet ditches feet ditches inches
French Drain Reouired: _ _ '1111rar fPpr
Authorized State Agent--. n,SS-4 ~V~ ~\A )~5 Date 611711
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