OPHTE# 5 Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 4 9
New Installation 'I Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: MP2ac5
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Name: (owner) v r, t3E~ ~~d a SUBDIVISION ~r>FOCta~ LOT # 0
System Installer: -TC-_Q Registration #
Basement with plumbing: ❑ Garage 'M Number of Bedrooms 1+
1 Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1C 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 comDhance with abDlicable north Larolma beneral Statutes, nines [or )ewaAe treatment and
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and all conditions of me Improvement rermlt and Lonstrucnon 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 ❑ No
IV. Operation:
V. Other:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above aptione roperty.
Type of system: ❑ Conventional ` Other C_W>,m~c~t'_ Septic Tank: Igallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 ~d feet ditches '3 feet ditches 3Q inches
French Drain Reouired: x.fe~
Authorized State Agent -11 CLz_ a5 _ Date 10' Wl\ )