OPHTE# 1 " Harnett County Department of Public Health 23042
PERMIT # ' (0 Operation Permit
l New Installation Seutic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ' i GIN
Name: (owner) 12> 6 L—L— \�NG., `eJ SUBDIVISION LOT # Co' P
System Installer: o ,4 C c-- S -4 ic -l:. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well I 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.
Inns system has Deen mstauea in compliance with applicable north tarmma uenerai statotes, Wes tar sewage treatment ana
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ana an conmuons or the improvement rermn ana tonstruamn eutnonzanon.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Reauire&-- `,,
maintenance and reporting.
i;C`
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the above captioned, property.
Other'.-AA , "'e, P-- ( Septic Tank: 1 000 gallons Pump Tank: gallons
exact length width of ry depth of
of each ditch J feet ditches feet ditches 3 inches
Authorized State Agent �.a ����t =�'' Date
13- -5-31 -1 4�t