OP RHTE# 1_�. -S -a' bb Harnett County Department of Public Health
PERMIT # Operation Permit 22446
New Installation 'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: "oszoF_
Name: (owner) oaK4 -J 0s-�� LJ—< . SUBDIVISION Sous LOT # —
System Installer: e<aaoEL Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community ;X Public ❑ Well Distance from well S OO 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.
This system has been installed in compliance wim applicable norm tarmma ueneraT matutes, nmes for sewage Treatment ana msposaT, ana an conamons m me improvement rermt ana construaTOn numorizanon.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capti ed property.
Type of system: ❑ Conventional Other C..µP -, kQS( Septic Tank: t OOU gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch aoo feet ditches feet ditches 3G'�� -i inches
French Drain Reouired:
Authorized State Agent A'W'4 " . ,�P�C -=�S Date
t=„ �
t,] l
t2, l
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capti ed property.
Type of system: ❑ Conventional Other C..µP -, kQS( Septic Tank: t OOU gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch aoo feet ditches feet ditches 3G'�� -i inches
French Drain Reouired:
Authorized State Agent A'W'4 " . ,�P�C -=�S Date
� a.: 5-aB 6sg�
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