OPHTE# 14° _� =—��.a Harnett County Department of Public Health 23169
PERMIT # ��1—1 Operation Permit
New Installation,)< Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:°— Tic��>wcv,,
Name: (owner) tc.t -mot z-cc Vitc,rN12.s SUBDIVISION PP iWo.5 LOT #
System Installer: S�F_T-TiG. SEszv -cam Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: El Community Public ❑ Well Distance from well � O 0 feet
System Type: c 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 has been mstaheb in compliance with applicable North larolma l eneral Statutes, Rules for Sewage Treatment and
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iDOMp�KER. ��
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and all conditions of the
YtnrllI LuINuiIluNi:
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:
Permit and Construction Authorization.
❑ ID-Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captione roperty.
Type of system: ❑ Conventional Other 01w�, Septic Tank: idCG gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage __ditches �_ of each ditch t 5® feet ditches feet ditches G inches
French Drain Required: ° Linear feet
Authorized State Agent � , �� \ \� ___ "�` Date 4 1
1 A
1
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M
and all conditions of the
YtnrllI LuINuiIluNi:
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:
Permit and Construction Authorization.
❑ ID-Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captione roperty.
Type of system: ❑ Conventional Other 01w�, Septic Tank: idCG gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage __ditches �_ of each ditch t 5® feet ditches feet ditches G inches
French Drain Required: ° Linear feet
Authorized State Agent � , �� \ \� ___ "�` Date 4 1