OPHTE# 1I Harnett County Department of Public Health
PERMIT #Operation Permit 2 211
New Installation N Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I W, NA-,N-1 %:4
Name: (owner) \rT Pr, c. n E5 CL15v1cs SUBDIVISION C,~.~.t,. - YcLc C,P ,-1 LOT #
System Installer: ~Eaa-y t ~CZ t g Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well VQ)O 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.
trus system nas peen instanea in compnance wnn appucame nortn tarouna aenerai matutes, naves [or Newage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)l
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: .,a'T P*-41-5 -Ti f.Q Zt-n a '1-i -s TEPr\
❑ 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 Septic Tank: 15 C~0 gallons Pump Tank: Std gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch feet ditches feet ditches inches
French Drain Reauired: n~ Ititre fle-~
Authorized State Agent 0~5 Date 91 M I )
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