OPHTE# 11 5-a~~c~ Harnett County Department of Public Health
PERMIT # ~G-14S Operation Permit 2 2 3 2 4
New Installation bk Septic Tank , `l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ML'CDoca6PL4 ey
Name: (owner) yJoN tuc-,~as~+ 1NC- SUBDIVISION Syc-,c"GW NIu- LOT # I6
System Installer: kAo=Orb PL,UMSN►aC' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _
Type of Water Supply: ❑ CommunityI Public ❑ Well Distance from well X OQ feet
System Type: ==XStl 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 mstanea in compuance with apphcame north carotma beneral statutes, naves for Sewage Ireatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
111. 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 system on the above captioned property.
Type of system: ❑ Conventional 'k Other E.Z Fti...et1F,r Septic Tank: MOO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Q~ of each ditch cl C) feet ditches 3 feet ditches I_ inches
French Drain Reauiiear`i
Authorized State Agent -1 ~ 62 f- )5 _ Date -5 I'll N a
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