OPHTE# ► '5 Harnett County Department of Public Health
PERMIT # Operation Permit 22868
`.13( New Installation X Septic Tank ,' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W
Name: (owner) i L.-,,a 1 one!5 SUBDIVISION C ;5,Q_.iai JOT # 4-3
System Installer: \,4 ",4 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 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.
[his 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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rLUM w111Jnwn3:
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:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned roperty.
Type of system: ❑ Conventional Other C" Ntt%� C-:L ((("Ax' Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 3
Drainage Field ditches � _-s ' itch `Z Q feet ditches ?�_ feet ditches 39 inches
French Drain Reouired: Lin�feet
Authorized State Agent ��►� \�.�. Date C ) &I
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