OPHTE# t3 ® ='S®6wa Harnett County Department of Public Health
PERMIT # � —5 Operation Permit 22545
New Installation )q Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) YE.r�eA COO-) Cy yr\in 65 SUBDIVISION LOT #
System Installer: J V L1-N�4 12) V Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: 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.
This system has been installed in compliance with applicable North l.arolma General )tatutes, Rules for )ewage treatment and uisposal, and all conmttons of the
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PERMIT CONDITIONS:
I. 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:
rermtt ana t,onstruction nutnonzanon.
V. Other:
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N 6 D- cyt
❑
D -Box ❑
Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abot caption4property.
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Type of system: ❑
Conventional Other
CIA Q,
Septic Tank: 100®
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch 308 feet
ditches
feet ditches 1$ "a�"� inches
French Drain Required:
eset
Authorized State Agent `� `�.� � �`�. �V2A -yJ Date 1
13 A 5 - 30CL.�