OPHTE# Q(0-S--I6'I Harnett County Department of Public Health
PERMIT # 23s3~ Operation Permit 21 5 4 2
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Oj c. -5 ii)C---4 Eu~sQt "-r, C- o SUBDIVISION G~, E*~►~ LOT # _
System Installer. 0-T,5 cz,c L ~s~S~ Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: 7M3~D 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage jreatme~pt and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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FEA1911 WNUMV11):
1. 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 11
No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other PUMP E-- "Z LAS Septic Tank: AOeQ gallons Pump Tank: 10 00 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 0-0 feet ditches 3 feet ditches inches
French Drain Reauired: Ii11Aar feet
Authorized State Agent _ 7~-- V`A'N- ~ i~~ Date ~AI'010
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