OPHTE# Q')-- Harnett County Department of Public Health
PERMIT # a6`~'~6 Operation Permit 22421
New Installation '*'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SQ•4vy YNUcnE.S LI-C- SUBDIVISION Kr-_NLj:,,,a 'ii:_txzA-5 LOT # S3
System Installer: NPaQ\r S~sG Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well E®C5 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.
Ihls system has been installed in compliance with applicable North larobna beneral )tatutes, rules for )ewage treatment and
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and an conditions or [tie improvement rermlt and lonstruccion Autnorizatlon.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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 captioned property.
Type of system: ❑ Conventional Other Z L-aw Septic Tank: 1 CSC) 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches - feet ditches 3O° )X inches
French Drain Reauired~ \ \ eet
Authorized State Agent Nom. e~~~~~ Date N
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