OP RHTE# Harnett County Department of Public Health
PERMIT #r q c Operation Permit 22361
dNew Installation Q~Septic Tank [_/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: _A/C
Name: (owner) v ~y n A Co„S- SUBDIVISION J /t e/t Pc LOT # 117
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community L~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.
tms system has been installed in compliance with applicable North larolma General Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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rtKMII cunuuluns:
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑
Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sews
disposal system on the above captioned property.
Type of system:
❑ Conventional Other ~uM /"Lo ~ZF~oe
Septic Tank: %CTC) G gallons Pump Tank: /000 gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches .3
of each ditch ® feet
ditches -3 feet ditches /8 `~5! inches
French Drain Required: Linear feet
Authorized State Agent S I C-22~r Date 2 2 2 d/ Z