OPHTE# 10- 5-'a14 sM Harnett County Department of Public Health
PERMIT # '-c6 \ Operation Permit 21 5 9 5
New Installation-'-,4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ZC) w Es-`
Name: (owner) \,I `t vA N Cc NS-~ tiv LN ) o N SUBDIVISION `ri Po ~a T -LOT # 10 0
System Installer: Re,, o) $ a,T t i Registration #
Basement with plumbing: ❑ Garage K Number of Bedrooms
Type of Water Supply: ❑ Community _CX~ Public ❑ Well Distance from well \00 feet
System Type: -_-_KMZ7 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.
[his system has been installed in compliance with applicable North Carolina 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.
II. 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.
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned pr
Type of system: ❑ Conventional ` Other C-N s>,~ ( Q v .c,- ~ J Septic Tank:
Subsurface No. of exact length width of
Drainage field ditches t of each ditch feet ditches
\ 0C7 C~ gallons Pump Tank: gallons
depth of
3 _ feet ditches S~ inches
french Drain Required: Linear
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