OPHTE# 15-r- Harnett County Department of Public Health 23940
PERMIT # 2 9J— 7z Operation Permit �/
ZNew Installation Septic Tank LTJ Nitrification Line ❑ Repair ❑ Expansion
n(� PROPERTY LOCATION: Af k ,,Lrxcl.
Name: (owner) /royal Oo kr 8a1l:ac G��A SUBDIVISION /s1lk.,,.r 1/: 1/, LOT #
System Installer. C m k' : Id er/ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community V�Public ❑ Well Distance from well feet
System Type: 1� c Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
hms system has been installed m compliance with applicable Norm camlma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa,disposal system on the above captioned property.
Type of system: ❑ Conventional fid Other Z F/ow Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches,3 of each ditch /ao feet ditches feet ditches kk" 16 inches
French Drain Required: Linear feet
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Authorized State Age .— E w o = y �Eif% Date aZ. ��/ ( of, G>
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