OPHTE# ~A _5-Ds~A Harnett County Department of Public Health
PERMIT # a- Operation Permit 21 9 2 6
New Installation -K Septic Tank ANitri6cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Oc c s
Name: (owner) yN~ ~o~a~:ctvGS~c~c~a SUBDIVISION \ Ti~czs t~~®r~E LOT # N\\f
System Installer: `-Ti oacgTdea3 L„ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 feet
System Type: 11 0~ 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.
ims sysrem nas Deen mstanea in compuance with apphcaDle north larolma beneral Statutes, Rules for
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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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ 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 s vJ Septic Tank: 1 o cNO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field difches 1 of each ditch Q feet ditches 3 feet ditches f~ inches
French Drain Required: LI feet
Authorized State Agent lar-SX5 Date 3 ':.31 )
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