OPHTE#O$'s~►a}42, Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 0 6
❑ New Installation ❑ Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: U5w2.1
Name: (owner) 5~ens~~. SUBDIVISION LOT #
System Installer: 1~.~~-y \~o~-L. fl Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms S~
Type of Water Supply: ❑ Communi I' Public ❑ Well Distance from well feet
System Type: ~w 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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PERMIT CONDITIONS:
1. 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:
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V. Other:
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❑
D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional ❑ Other 1144 LQ e Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of exact length width of
depth of
Drainage Field
ditches of each ditch feet ditches
feet ditches inches
French Drain Required: _ ine eet
Authorized State Agent ~ ~ , P-EA5 Date a