OPHTE# 1I-ems--~ Harnett County Department of Public Health
PERMIT # ' 7 ~L Operation Permit 2 21 0 6
'X New Installation =Ek Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: WILL 1-06P,~5'
Name: (owner) 'E>, -L-a- VA ® +n SUBDIVISION CAC-o>...P, d s -LOT # 26,
System Installer: 44 ",r4 IZcs 4 e.5 Registration #
Basement with plumbing: ❑ Garage -)!5L, Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
ims system has neen installed in compliance with appucanle north tarouna General Statutes, fmles for Sewage Ireatment and
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 ❑ NaX
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caps ned property.
Type of system: ❑ Conventional Other C S P'Ep_ Septic Tank: ~COQQ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 each ditch \ W feet ditches feet ditches &-1-1~ inches
French Drain Required: 1.1 et -1-1
Authorized State Agent Date -'6 1
1 42
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