OPHTE#_1~(-(A Harnett County Department of Public Health
PERMIT # a~-~a~.. Operation Permit 2 2 7 0 5
iE-=F; 60T% Nitrification Line El Repair A Expansion
PROPERTY LOCATION:_ QvtSt,~+,y
4. ~L
Name: (owner) SUBDIVISION 5-r®rA~.CA-ZZS5 LOT # (<3_
System Installer: kA e n~L~ ~,c.~~ ~,cZ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms i>
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 140 feet
System Type: E„ 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.
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PFRMIT rnAlnlTinmK.
wan appucame norm Larolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and Construction Authorization.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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❑ 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 ~s'+Am43F.~ Cam Septic Tank: Y.ol)VINNC, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field -ditches 1 of each ditch GO feet ditches - feet ditches -).L1^ `4 inches
French Drain Reauired_ _ , I ina ppr
Authorized State Agent t,~ U-A! 5 Date ) )'`1l N
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