OPHTE# `�- a��� Harnett County Department of Public Health
PERMIT # a-7) Operation Permit 22769
New Installation 4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -'-TvN c Via,
Name: (owner) M S@ C,ot, s SUBDIVISION LOT # 1
System Installer: Q> v—, 1--5 Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
rtnrui tununiuns:
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nq
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 above captioned property.
Type of system: ❑ Conventional �< Other E-7— V-.-ow Septic Tank: !(o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch feet ditches feet ditches 1' " inches
French Drain Required: tom_ _ \ feet
Authorized State Agent '�
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