OPHTE# ��- - a��37 Harnett County Department of Public Health
PERMIT # �� ®63 Operation Permit 22450
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
--�-� l PROPERTY LOCATION: i``1Q-
Name: (owner) Ect.- 1,10nV 6 C�yr� .s SUBDIVISION N---, �-i 0Q.0 LOT #
System Installer: lsc� B(Mww Registration #
Basement with plumbing: ❑ Garage "X Number of Bedrooms "
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 O C7 feet
System Type: __1_1__ A 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above tioned operty.
Type of system: ❑ Conventional Other �""G.0 - Septic Tank:
Subsurface No. of exact length width of
Drainage Field `3ifdrm , of each ditch ) feet ditches
French Drain Reauired: _ Line3riteZ,
Authorized State Agent y \�''v` "�3 \� Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
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