OPHTE#-\ Harnett County Department of Public Health
PERMIT Operation Permit 2 2 21 1
New Installation 'X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 i N N
Name: (owner) o..s,_1- Lvcp-6 SUBDIVISION 1?m; %A5 LOT #
System Installer: S Ras3-,- c--~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1Q0 feet
System Type: c. 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.
Ims sYStem has been mstaneU In compliance with applicable north larollna beneral )ta[utes, pules tor sewalze Treatment and Ulsposal, ana an conolllons or the ImproVement rermlt ana lonstruction Authorization.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noxl
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the abo a capt ed property.
Type of system: ❑ Conventional '154, Other CAc\-,(- L- `k J Septic Tank: tbb~1 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1-C) feet ditches 3 feet ditches a
French Drain Required: ar~0fst,
PWR Line
gallons
inches
Authorized State Agent ~~~~y C-V,5_ Date
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