OPHTE# ®35 Harnett County Department of Public Health
PERMIT # � Operation Permit 22760
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC—'2):1
Name: (owner) "x4 r��-qeKc, VA SUBDIVISION �t G LOT #
System Installer: 0-r ) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community '1�k Public ❑ Well Distance from well O 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.
ims sysrem nas peen nscaueo in compuance wim appncame Norm iarouna uenerat statutes, rules for Newage treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
nUoo 09—
rtnrnt LUIV1,1111UNY
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 ❑ Noy
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ 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 1;-OW Septic Tank: 1000 gallons Pump Tank: _
Subsurface No. of exact length width of depth of ,g
Drainage Field ditches of each ditch 8 0 feet ditches feet ditches
French Drain Required: feet
Authorized State Agent ������_\ 9 G—, Date
PWR Line
gallons
inches