OPHTE# o -5 5) Harnett County Department of Public Health
PERMIT # Operation Permit 21 6 2 7
New Installation 'E~, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a7
Name: (owner) \,I `'N a C-0 --v5'crr vc r~a,.,t SUBDIVISION _t f,,, E,,, Po LOT #
System Installer: ~a~-► SSA
3 Registration #
Basement with plumbing: ❑ Garage ~ Number of Bedrooms
Type of Water Supply: ❑ Community '19. Public ❑ Well Distance from well y00 feet
System Type: 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.
nns system nas peen mstaneo in
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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DCDMIT rA\In ITIAUf
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V
I. Performance
11. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. QV
LL 1e ~E
❑
D-Box
I~ Pump 2( Alarm ❑
H201-ine ❑ PWR Line
Following are the spec
ifications for
the sewage disposal system on the above captioned property .
Type of system: ❑
Conventional
X Other P vrnP Ia C~ip~ g~~Qt~,~e L11~ Septic Tank: t ooG
gallons Pump Tank: 1a4O gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field _
ditches
S of each ditch -2~-- feet ditches 3
feet ditches t inches
French Drain Reauired:
I MPAr (AAt
Authorized State Agent\ Date °1
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All
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