OPHTE# \ Harnett County Department of Public i ealth
PERMIT # Operation Permit 2 2 2 0 3
71< New Installation '~K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C.yPc2 Est Ci~r~
Name: (owner) V oc^c,,,t V^I e- SUBDIVISION G-1W.e55 foN LOT #
System Installer: Sta sow ` n tan N lC -4 > Registration #
Basement with plumbing: ❑ Garage 1~kNumber of Bedrooms Ll
Type of Water Supply: ❑ Community 'IR Public ❑ Well Distance from well ~ 00 feet
System Type: > > b 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.
finis system nas peen mscaueu in compuance wan appucaoie norm t.arouna oenerai xatutes, awes for sewage Ireatment and
and all conditions of the
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Permit and Construction Authorization.
rt:nrul WNUIIIUNY
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 stem on the above captioned property.
Type of system: ❑ Conventional Other 9urV--'~ t o 53. y Septic Tank: gallons Pump Tank: I gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch a00 feet ditches 3 feet ditches AO inches
French Drain Required Linearlyqtl
Authorized State Agent
~IQNI"<_ 14_~41_1 V--N5 Date 1 l~ 1 la
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