OPHTE# 10- -atia Harnett County Department of Public Health
PERMIT # Operation Permit 21938
I New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N\c=<2'~,& V,.~>
Name: (owner) Yes~ Q~ a t E SUBDIVISION ~ ~\C_50~zD LOT #
System Installer: 77-c -D 9,0"w-J Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Commum 1< Public El Well Distance from well \b feet
'N c"
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.
lms system nas been mstanea in
witn applicable North larolina beneral )tatutes, Rules for
Ireatment and Disposal, and all conditions of the
Permit and Construction Authorization.
rtKMII LOOM):
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
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 captione&roperty.
Type of system: ❑ Conventional `X , Other ~tz Septic Tank: G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch of each ditch taC7 feet ditches feet ditches inches
French Drain Required: _ Lineofeet
Authorized State Agent Date g114
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