OPHTE# Id, --r- zS Harnett County Department of Public Health
PERMIT # )0111 Operation Permit 22387
ErNew Installation Septic Tank °fl'— Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ��-���= i 8�:1'�t SUBDIVISION E LOT # / y6
System Installer: 1-i�ey Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms ...3
Type of Water Supply: ❑ Community 6Q Public ❑ Well Distance from well 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 with applicable North Carolina General Statutes, 8ules for Sewage ireatment ana ursposai, ana an commons or one improvement rerma ano conscrucrion xumorizauon.
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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 ❑ 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
Type of system: ❑
for the seewwap disposal system on the above captioned property.
Conventional E2' Other E 2- Flo U' Septic Tank: °00
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length width of
ditches of each ditch 7S feet ditches 3
depth of
feet ditches `���� inches
French Drain Required: Linear teet
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Authorized State Agent �— l' e7 Date
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