OPHTE# `1~~ Harnett County Department of Public Health
PERMIT Operation Permit 2 21 2 0
New Installation '~R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~os s~ ti i"S Qb
Name: (owner) C. ~av~cs }FSLN SUBDIVISION ►'sSe+r, LOT #
System Installer:="E;A~j MPpa =CS Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ! ® Q feet
System Type: moo' 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 Carolina General Statutes, Rules for Sewage 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.
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:
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❑
D-Box ❑ Pump ❑
Alarm ❑ H20Line
❑
PWR Line
Following are the speci
fications for the sewage disposal system on the abov captio
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property. \
Type of system: ❑
Conventional
K Other
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Septic Tank: 1®0V gallons
Pump Tank:
gallons
Subsurface
No. of exact length
_
width of
depth of
Drainage field
ditches of each ditch \
'8 0
feet ditches 3 feet
ditches
a~ '3b inches
French Drain Required:
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Authorized State Agent \ \ ~c-i5 Date -i1 I 1 ~
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