OPH T E # Id -ALNCZ," , Harnett County Department of Public Health
PERMIT #Operation Permit 21 5 6 8
New Installation X Se tic Tank >q Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Va r pFtt.~~,~r
Name: (owner) ~ ~ a.~ s~ s SUBDIVISION LOT # 1
System Installer: Lt,y t>'Awq,(--- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \CO feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) r Owner must contact Health Department 6 months prior to expiration for permit renewal.
.no ,Y-111 nas ueen mstaieo in
with applicable North Carolina General Statutes Rules for
w
Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
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 ❑ NoV
IV. If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Operation:
V. Other.
❑
D-Box
❑ Pum
❑
l
p
A
arm ❑
H20Line ❑
PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Subsurface
Conventional
N
Other T1Q4,- CA1,N°5 Septic Tank 1Q~
gallons Pump lank: gallons
Drainage field
o. of
ditches
exact length width of
of each ditch W f
t
depth of
French Drain Required:
ee
ditches
feet ditches inches
Authorized State Agent_ Date ~
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