OPHTE# P"5 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 7 2 8
New Installation D~ Septic Tank -X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V) C) o u q, P ~ RZ
Name: (owner) Mess ac~~ ~ON>--~JEQ-5 SUBDIVISION VNCZ ( OgN-a 1-NC'F- LOT # '4,
System Installer: ho+v N-C-- sa N Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: El Community Public El Well Distance from well 100 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.
PERMIT CONDITIONN:
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 ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned propertyo Septic Tank: 10 gallons Pump Tank: 1(t)00 gallons
Type of system: El Conventional Other PV'MP 1 0 L2 Subsurface No. exact length width of depth of
of each ditch GO feet ditches 3 feet ditches 30'~O inches
Drainage Field ditches
French Drain Required:
Authorized State Agent 3 M Date
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