OPHTE# 13-'5-3 Harnett County Department of Public Health 23163
PERMIT # ';L'-A;L`I 5 Operation Permit
New Installation ""K Septic Tank �< Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: �s�� �7' {2
Name: (owner) SUBDIVISION EEf5s,E H (2�Yr�'o LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community 'IX Public ❑ Well Distance from well t ®O feet
System Type: o, 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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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:
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MLN( L_QU [�Prj $
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❑
D -Box ❑
Pump ❑ Alarm
❑
1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional Other
Septic Tank: 1000
gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field __
ditches
of each ditch k o c2 feet
ditches
feet ditches I -ate inches
French Drain Required:
_ _-._
Linear_ feet
Authorized State Agent Date