OPHTE# Q `S `3 118 6 Harnett County Department of Public Health
PERMIT # a- q5-6 Operation Permit 22946
EE'- New Installation E- S�ticTlank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) lr�Jn✓��o�s rv� �� SUBDIVISION ��w -%t �s� LOT # Ir
System Installer: -TV,,- ,� r P / ,JA-b' Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 2'—Public ❑ Well Distance from well feet
System Type: :TIE G— 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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rtKMII LUNUniuNS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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 sewap disposal system 5n the above captioned property.
Type of system: ❑ Conventional Other ZG /ow Septic Tank: ZC0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of , l
Drainage Field ditches o2 of each ditch /00 feet ditches 3 feet ditches � 7 inches
French Drain Required: Linear feet
C � % /10/'? Authorized State Agent �o-� -. �ij Date Tl d �
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