OPH T E # lo~sa Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 6 8
1 New Installation )K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~ rY,~~~~ SUBDIVISION 5uN-,c,. LOT # Saa
System Installer: O-cvs Registration #
Basement with plumbing: ❑ Garage 'T~W, Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
uns system nas oeen mstaueo in compnance wttn appncame noun carolma General hatutm, awes for )ewage Ireatment and Disposal and all conditions of the
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Permit and Construction Authorization.
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1. 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.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other L-2-
Subsurface No. of exact length
Drainage field ditc S of each ditch 1i O feet
French Drain Required: -~inear feet
Alarm ❑ 1-1201-ine ❑ PWR Line
Septic Tank: 100 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 19`3 inches
Authorized State Agent Date iiN
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