OPHTE# 1 1-5-2 1~-1 cl~ Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 0 7
New Installation "5~ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: T'\ Pais
Name: (owner) SUBDIVISION C NE-g:.Oap LOT # $7
System Installer: 7-Tio 5(t-j.tjr4 Registration #
Basement with plumbing: ❑ Garage~ Number of Bedrooms L
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: "ITT 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.
mts system has been mstahea to compliance with applicable north l.arolma General Statutes, Rules for Sewage treatment and
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and all conditions of the
W')w>JGN7C Q 9__
Permit and Construction Authorization.
rt rinn Lunurtluns:
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 system on the above caff tioned ~perty.
Type of system: El Conventional Other CN-s \ s n~3 ~ l QA Septic Tank: 1, b 4 O gallons Pump Tank: gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch -10 feet ditches '2> feet ditches &'A-30 inches
French Drain Required: .feet
Authorized State Agent v ` ~ U--I Date
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