OP RHTE# ` L-5-~~ N, Harnett County Department of Public Health
PERMIT # 'Z`C Operation Permit 22231
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Me)oUC~~ V:~,D
Name: (owner) ~H~:~S ~tir►~. ~~trl~+e~5 SUBDIVISION ~PeJtAN \ONu--~Py,S LOT #
System Installer: Q..\ c--4- -l \NOL . t7 Registration # T
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well f C3 C3 feet
System Type: s e, 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 larolma heneral )tatutes, nines for )ewage treatment and uisposal, ana all comnlions of me improvement rermit am! t.onstrucdon Autnorization.
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PERMIT CONDITIONS:
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-N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑
Following are the specifications for the sewage disposal system on the abo e captr d property.
Type of system: ❑ Conventional "Kf Other C.~vKi6i!3;rt,~'~ / Septic Tank: 10 0 Q gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch y feet ditches 3 feet ditches t Q
French Drain Reauired; ,z-- feet
PWR line
gallons
inches
Authorized State Agent- O--t•~" Date -31)1 Q-
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