OPHTE#Harnett County Department of Public Health
PERMIT # 2 ~S~o Operation Permit 21 9 8 9
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: r Se ~
Name: (owner) \Ao m Z-5 SUBDIVISION P®.;yt:~,As -9ot ts-, LOT # -1
System Installer: \r4P.J s-4'-_ Jo Registration #
Basement with plumbing: ❑ Garage '2~ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 b0 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.
This system has been installed in compliance with applicable North Larohna beneral Statutes, rules tar Sewage Ireatment and
q a.,
and all conditions of the Improvement rermt and LonstrUChon Authorization.
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:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the abo a capti d property.
Type of system: ❑ Conventional Other ~NP~tYr~ (Q~A Septic Tank: gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch d2~ feet ditches feet ditches inches
French Drain Required-
,-1-.-Authorized State A¢ent Date 1 `7 T
S:, 9" CP-+►eE9- CJ2
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