OPHTE# t0-5--~4115- Harnett County Department of Public Health
PERMIT # 'D~l -1 Operation Permit 21 6 4 5
New Installation N, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1-i NCE 0
Name: (owner) ~tar_SY, Co,AtrT SUBDIVISION poN5 Qo.N-c LOT #
System Installer. L A9=gzj S,~ o,2P E Registration #
Basement with plumbing ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community'
ommunity Public ❑ Well Distance from well CO 0 feet
System Type: -=Ky- 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.
in's system nas 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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PERMIT CONDITIONS:
I. 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
IV If yes, see attached sheet for additional operation conditions, maintenance and reporting.
. Operation:
V. Other
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other i t (Lr-- Ley p5 Septic Tank: %000 gallons Pump Tank:
Subsurface No. of exact length width of
Drainage field ditches depth of gallons
of each ditch 2. O feet ditches 3 feet ditches 1 inches
french Drain Reauired~a .
Authorized State
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