OPHTE# 10-5-D~ y~5G Harnett County Department of Public Health
PERMIT # a~a3'1 Operation Permit 21 7 5 2
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t''lPa_
Name: (owner) SUBDIVISION Co oe C F'arz,,,5 LOT # t-
System Installer: Cam. s 5- 0-\C-XL_eIo Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \ O 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.
...u ~ru<m ua3 ueen ootaneu in compuance wfm appucaoie port tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT rn1in ITIn IIC.
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Permit and Construction Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other C Z FZ o i
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch feet
French Drain ReauireiL \ v f
Alarm ❑ H20Line ❑ PWR Line
_ Septic Tank: t O C> O gallons Pump Tank: gallons
width of depth of
ditches feet ditches ati-3(, inches
Authorized State Agent Date to l )