OPHTE# -aka} Harnett County Department of Public Health
PERMIT # :7 ® Operation Permit 22511
New Installation Septic Tank IX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C-lei. E,-,s Ggutz C,yj
Name: (owner) SUBDIVISION C-JS'9--c-ss ?o,N`TF- LOT # fa.
System Installer: VN sa i t tip. -•ate Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: c 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.
finis system nas peen mstauea in compliance with appucaDie North t.arouna benerao statutes, limes tor sewage treatment and omsposai, and all conditions of the
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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Permit and Construction Authorization.
-3-31,
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E-Z 1-csw Septic Tank: le�PO gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ��itthes.� 1 of each ditch DO feet ditches $a feet ditches
French Drain Required: � eet
Authorized State APent 9--t14> Date __ 101.3
PWR Line
gallons
inches
I �, 5-;36 av�