OPHTE# is s �� y�� Harnett County Department of Public Health
PERMIT Operation Permit 22396
R' New Installation ltd' Se tic Tank 0' Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: 711^ 44—r, 0rc. ,e-t
Name: (owner) 7S_er SUBDIVISION S✓'d- S"— LOT #
System Installer: o �� �Stc��,Lo Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms3 � V /" -Y
Type of Water Supply: ❑ Community F''Public ❑ Well Distance from well feet
System Type: Z7L —Cr 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
with applicable North Larolma General )tatutes, Wes for )ewage treatment ana msposai, ana an conamons m me
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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:
rermtt ana construction Numorrzanon.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewape disposal system on the above captioned property.
Type of system: ❑ Conventional V Other G 2_,6:E/d L-j Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches °2 of each ditch ° feet ditches _ feet ditches 3° - z`/ inches
French Drain Required: Linear feet
Authorized State Agen v'�- �C���f Date �a �°�94_11 1/Z