OPHTE# Harnett County Department of Public Health
PERMIT # Z ``yc Operation Permit 2 2 0 7 6
MNew Installation LEI Septic Tank ER/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: gi2 ,530 ~ l V3
Name: (owner) "~~b!a:= ei r SUBDIVISION ,47-:5 fA r-S LOT # ~
System Installer: 1 Registration #
Basement with plumbing: ❑ Ga ge ❑ Number of Be rooms 3
Type of Water Supply: ❑ Community ❑ Public Well Distance from well fact ° feet
System Type: ~~'~iatL osa J s L%t. ~ & r-ZCAY Types V and VI Systems expire in 5 years.
(In accordance with Table V a) F Owner must contact Health Department 6 months prior to expiration for permit renewal.
uus system nas Peen insraueu in compuance wim appucame norm Larouna jeneral xatutes, KUM for )ewage Treatment and
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1. Performance: System shall perform in accordance wit ule .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 sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: / gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch C feet ditches feet ditches 24 inches
French Drain Required: Linear feet
Authorized State Ag Date /7--43 t 1
and all conditions of the Improvement Permit and construction Authorization.