OPHTE# Q_~ '5_ )6` LiP Harnett County Department of Public Health 21799
PERMIT # a Operation Permit X New Installation 'FA, Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1- My c L L sic x
Name: (owner) Hy-s- , 7Ev\jiF-\n.C~ SUBDIVISION LOT # -IT
System Installer: 07-5 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms -3 -
Type of Water Supply: ❑ Community .A Public ❑ Well Distance from well LOO 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.
This system has been installed in compliance with applicable North larolma 17eneral statutes, awes tar )ewage Treatment ana uisposal, ana all cony ions of me improvement rermlt ana construction nutnarizatlon.
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PERMIT CONDITIONS:
1. 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 ❑ ol
If yes, see attached sheet for additional operlooo c(c I
IV. Operation:
V. Other:
maintenance and reporting.
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are th
e specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional Other
S7~w
Septic Tank: tnOQ) gallons Pump Tank:. gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch )'10 feet
ditches 3 feet ditches L19 inches
French Drain Required: e
Authorized State Agent ffNS Date %a
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