OPHTE#CP1-5--al(1% Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 9 4
New Installation "E~ Septic TankA Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ® we, C N's- ~Acoc, SUBDIVISION \Aezo LOT # W .
System Installer: -:Yo,a Registration #
Basement with plumbing: ❑ Garage '19 Number of Bedrooms --'5
Type of Water Supply: ❑ Community _0\ Public ❑ Well Distance from well N a 2 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.
ims system nas peen mstanea in compuance wan appucaoie norm Larotma uenerai xamtes, nines for sewage ireatment ana visposai, ana an conamons or me improvement rermt ana constructmn Auinorization.
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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 ❑ 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 captioned property.
Type of system: ❑ Conventional Other 9vr•e-To E--Z- F'LZr v Septic Tank: aQ Q3 gallons Pump Tank: i®OG gallons
Subsurface No. of exact length width of depth of
Drainage Field diof each ditch O feet ditches 3 feet ditches inches
French Drain Required: Authorized State Agent Date a3 IN
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