OPHTE# Harnett County Department of Public Health
PERMIT # 'a kS I Operation Permit 2 2 2 2 8
TX" New Installation 'I!k Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner)€~ SUBDIVISION LOT #
System Installer`- n, ~O 0S P J C'r-' ~ Registration #
Basement with plumbing: ❑ Garage; Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 'tO 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.
finis system nas peen mstanea in compuance with appucame north tarouna uenerai statutes, haves for sewage Treatment and
and an conditions or the
l4cil l
a Mrs,;,
rermTt and t.onstructlon Authorization.
PERM WNUIIIUNS:
1. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation cc
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional IN Other ZZ csw Septic Tank: i®® d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field k~tches of each ditch ® feet ditches .3 feet ditches 1iV°~1--N inches
French Drain Reauired:' \ inea
Authorized State Agent __~\L ¢~~s Date 3
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