OPHTE# lt- J-- a"-) W Harnett County Department of Public Health
PERMIT # 02 a Operation Permit 2 2 0 3 5
2/New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~c.~~/to✓' ~~~an•~✓
Name: (owner) Sort R~ Z SUBDIVISION LOT # r,2-
System Installer: jLA • 4e Xcv Registration #
Basement with plumbing: ❑Garage C~Number of Bedrooms .3
Type of Water Supply: ❑ Community lr Public ❑ Well Distance from well 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 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 121
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewgge disposal system p the above captioned property.
Type of system: El Conventional 0 Other
Subsurface No. of exact length
Drainage Field ditches of each ditch oZ-Uj feet
Alarm ❑
H2OLine ❑
Septic Tank: /ono gallons Pump Tank:
width of depth of
ditches feet ditches 30` zy
PWR Line
gallons
inches
French Drain Required: Linear feet
Authorized State Agent DateX2- V"/
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