OPHTE# 1 a- -5 -a�aa. Harnett County Department of Public Health
PERMIT # a—� Operation Permit 22604
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT # d
System Installer: S t--z.5-- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms �L
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well 1 `130 feet
System Type: t 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.
tnis system nas peen installed in compliance with appucame norm tarouna uenerai
02
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Wes for )ewage treatment and uisposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
II. 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 for the sewage disposal system on the abo a captio ed property.
Type of system: ❑ Conventional '5� Other Septic Tank: tQ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche of each ditch d feet ditches feet ditches inches
French Drain Reouired: Linear feet
Authorized State Agent Date X11:0