OPHTE# L Harnett County Department of Public Health
PERMIT # P6 ba Operation Permit 2 21 1 9
New Installation4l Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Iow~si. q.D
Name: (owner) Cy rnpe4z,L-e%,,c, NA0nZ--;, SUBDIVISION ► sa~t✓,.~ s~e-E LOT # 1`3
System Installer: ~ w N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1O P feet
System Type: -o. 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 larolma benerai Statutes, Mmes for sewage treatment and Disposal, and all conditions of the
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Permit and l.onstruction Authorization.
1-34,1,.
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 ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Reauired: - -
Pump ❑ Alarm ❑ H201-ine ❑
sewage disposal system on the above capt ed property.
' Other Septic Tank: I0c C gallons Pump Tank:
exact length width of depth of
Hof each ditch k6Q) feet ditches T feet ditches a
PWR Line
gallons
inches
Authorized State Agent y~\ P~ `7 Date 3'
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