OPHTE# 1a-'5f~-Its Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 1 5
New Installation ~ Septic Tank X N+'trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \AN rj ~Q
Name: (owner) \-rl y ~ N C o ~4 c" c;~; ~ 0 A SUBDIVISIOM^ 1 i,J 6 a-t Va'',' e. LOT # 106
System Installer: ~0 U' C2 s1N s Q vc<.'~p \+4 C- Registration #
Basement with plumbing: ❑ Garage -~K Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tia a 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 General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nq.
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: a eC2.' L_1 ea -S5 ~ v Lt~~. U P~oPfn_ 5S,- -kq;p',-s) 0 j
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal stem on .1k above captioned roperty.
Type of system: ❑ Conventional ' Other U~ ' 1 T-- . Vi --r Septic Tank: kiZ) 0 6 gallons Pump Tank: 1 OZQ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch -73 feet ditches feet ditches inches
French Drain Reauired:,'~. '
Authorized State Agent , I vy\ ~ N~-, . y Date 'a 441 h
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