OPHTE# /d-s = aV~76 Harnett County Department of Public Health
PERMIT # I - Operation Permit 21 5 9 8
Q/New Installation L2erSeptlc Tank I2Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 11i;2, Al'
Name: (owner) SUBDIVISION LOT #
System Installer: C~ cam: t f~~ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well feet
System Type: ZX G 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.
um ipiein uas peen mssaueo in
wan appucame norm tamma beneral statutes, Kole% for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
Lill 111 LV11VIIWrl.).
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.
9M F(23 to D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine wr PWR Line
Following are the specifications for the sew a disposal system on th above captioned property.
Type of system: ❑ Conventional Other ~s Septic Tank: 1600 - gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 2 of each ditch._ feet ditches feet ditches o2 inches
trench Drain Required: Linear feet
Authorized State Agent ~~-K,, Date ~~1~
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