OPHTE# Jo-5-' >'~3'~- Harnett County Department of Public Health
PERMIT # S~ Operation Permit 2 2 2 0 6
New Installation 19 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC°1 ~N
Name: (owner) \t4 -1n ~ Cc czJyC' v,1 SUBDIVISION ~ta3G~r1 ~y N- LOT #
System Installer: I V-~G-nc) ras P L-v fiq N G Registration #
Basement with plumbing: ❑ Garage 151- Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l® ® 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
PERMIT CONDITIONS:
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
If yes, see attached sheet for additional operat n conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above ca tioned property.
Type of system: ❑ Conventional Other Pvv"?_Td E7- a-o-y~r
Subsurface No. of exact length
Drainage field ditches , of each ditch a a5 feet
French Drain Required:- _ et
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: tid®® gallons Pump Tank: VM gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Aeent W_> Date 1113
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