OPHTEAS -5''51371
PERMIT #'`blo»
Name: (owner) f'laaczxL—ti Wt -t
System Installer: EooN e
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type:
(In accordance with Table V a)
Harnett County Department of Public Health 24012
Operation Permit
New Installation 'N Septic Tank Nitrification Line ❑ Repair ❑ Expansior
QQ PROPERTY LOCATION: (5�
7v
1t_0P12s SUBDIVISION M o.2vs:< 9s -P cl: LOT # to
�ert� Registration #
Number of Bedrooms 3 .�
Public ❑ Well Distance from well 1 f SJ feet
y, Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
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 th sewage disposal
system on the above
f optioned �Qpe�ty.
Type of system:
❑ Conventional Other
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Septic Tank: t000'
gallons Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage field
ditches (
of each ditch
feet ditches 3
feet ditches inches
French Drain Required: 'kaear feet
Authorized State Agent 9Z1i5 Date
Nil