OPHTE# J1 2 -1- Z105(, Harnett County Department of Public Health
PERMIT 3 Operation Permit / 22458
New Installation L?1 Septic Tank L?1 Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION- -3w—i-7 -q,3 / P-0
Name: (owner) - is SUBDIVISION LOT #
System Installer: G Registration #
Basement with plumbing: ❑ Garage � umber of Bedrooms
Type of Water Supply: ❑ Com unity l Public ❑ Well Distance from well jandl
System Type: Z `7' 6. aZ, Types V anexpire in 5 years.
(In accordance with Table V a) Owner must contact Health Depanths prior to expiration for permit renewal.
This system has been installed in compli ce with applicable North C rolina G Statutes, Rules for Sewage Treatment and Dispditions of the Improvement Perm it and Construction Authorization.
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PERMIT CONDITIONS: p�
I. Performance: System shall perform in accordanc�fi Ru"1A 961. �%
11. Monitoring: As required by Rule .1961.
Ill. 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 ❑ 1-12O1-ine ❑ PWR Line
following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other ,5 /b jC —&CtA -- , Septic Tank: 1006 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch "75 feet ditches 3 feet ditrhps AI i—b-
French Drain Required: Linear feet „.,,..
4uthorized State A Qtn2::� Date