OPHTE# 13 -5-c11391 Harnett County Department of Public Health 24692
PERMIT # 2ci 53a Operation Permit
mew Installation l�ptic Tank B-1trification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION: 6c,Jd e
Name: (owner) 5anea 9 fA"rn Q,%cr4 SUBDIVISION LOT # 5
System Installer. (j Itarcx Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community ❑ Public li�`Well Distance from well 14bl feet
System Type: S 6 %u ha Aix L'i' 5 t Erb =Tfl�4 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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all condiment of the Improvement Permit and (omiruction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ly
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. 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 ❑- Ot er CJ J Chow (s 1 Septic Tank: OcG gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a of each ditch L-C� feet ditches _ feet ditches ab inches
trench Drain Required: Linear feet
Authorized State Agent _�, /mss Date cl?Zzo/aa/:f-
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