OPHTE# li iU� Harnett County Department of Public Health 23303
PERMIT # Operation Permit
New Installation 1K,, Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: 1P6la� �+0,oN,3G�gt!
Name: (owner) (owner) Gv""4-4-Y C-- SUBDIVISION V)AvNtit. �2)G" Q-,00c LOT # (cO
System Installer: V1 9P CM ) r,,j ( EQ 7 i C— Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well E C)0 feet
System Type: 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 installed in compliance wftn appucanle north Larohna t,eneral )tatutes, Rules for )ewage Ireatment and
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rumii LUNNIUNS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No l
If yes, see attached sheet for additional operation cc
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and all conditions of the
maintenance and reporting.
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❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal s_Ystem 42 the above captioned property.
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Type of system: Conventional ) Other C, — z-kN ' Septic Tank: �00C)
Subsurface No. of `� exact length width of
Drainage Field ditches of each ditch feet ditches 3
French Drain Required: Linear feet
. , . , . I!,li %'���i� jet /" s 11 .
Permit and Construction Authorization.
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches