OPHTE# i Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 0 4
New Installation 'N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'f`'1 PAaL` Q-o
Name: (owner) e-s~ ~v Mc-, t tv c, s SUBDIVISION ~y5 3iSsForLfl LOT #
System Installer: OT ~s n.•~.~~.A~+9 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well lb C> 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 Carolina beneral )tatutes, Rules for )ewage Ireatment and U¢posal, ana au conamons of the improvement rermt ana constru tlOn Autnorization.
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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 ❑ No5ir
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 Other 'Z... i-}W Septic Tank: \ Q ®CI gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch -7 5 feet ditches feet ditches 28 inches
French Drain Required: Linear feet
Authorized State Agent Date q 17