OPHTE# g.._ 0-7 &41-5- Harnett County Department of Public Health
PERMIT # Z o/ Operation Permit 2 2 2 6/2
New Installation Septic Tank Nitrification Line E] Repair ❑ Expansion
PROPERTY LOCATION: 1-7&' ~a
Name: (owner) ~r.. ' SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 200 -S
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
system Type: P,-,:, h 7a r fy16- ~ <,,Atz- 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 nas peen installed in
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wim appllcadle norm Larouna t,eneral matuteS, Wes for sewage Treatment and Ulsposal, and all conditions of the
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Permit and l.onstructlon Authorization.
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rtnrtit t.unuiitunz
1. Performance:
If. 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 operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned proffer .
Type of system: ❑ Conventional I~ Other 1aT t~~a -septic Tank: 2000 gallons Pump Tank: ~ & gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / feet ditches feet ditches 'Z(0->1 inches
French Drain Required: Linear feet
Authorized State A ent Date -3--
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