OPHTE# 11--5-3n)'05 Harnett County Department of Public Health
PERMIT # a~~5 Operation Permit 2 2 41 4
New Installation ~k Septic TankX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: P'1►c. o-,4Ec2.9-a
Name: (owner) t,w,eEIILPf ~ ~O s 1,4 C' SUBDIVISION -TiN6c., LO'
System Installer: 1ss, `,r" Registration #
Basement with plumbing: ❑ Garage )K Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: cr. 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.
# 3)
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.
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abovf ccaptio property.
Type of system: ❑ Conventional V Other C,_,-'c ~GsZ ~ / Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch feet ditches 3 feet ditches ~A --30 inches
French Drain Reouire&~**,%- _ ® et
Authorized State Agent. (Zd-6 Date '1130
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