OPHTE# ►o - 5-'_1s - Harnett County Department of Public Health
PERMIT # a c 3 Operation Permit 21 7 6 2
New Installation "N Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~1N2E4?-o
Name: (owner) W ayNE ~P+Mg~a SUBDIVISION Ftzft% Z LOT # 0.15
System Installer: Q5yc 7ra2~~CVLLpYr z p Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _3 _
Type of Water Supply: ❑ Community Public ❑ Well Distance from well j40 feet
System Type: A 1~ a, 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.
This system has 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
17b/
❑ 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 1=_Z1CL0w
Septic Tank: i 04o gallons Pump Tank: gallons
Subsurface No. of exact length width of
Drainage field ditches l depth of
of each ditch 18 b feet ditches 3 feet ditches 1'9 inches
French Drain Required: T%_- teat
Authorized State Agent_ Date 106.511 O
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