OPHTE# r �.��b-� Harnett County Department of Public Health
PERMIT # `-=3 Operation Permit 22777
New Installation '&� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: CNKZ;--'5 tp
Name: (owner) tap SUBDIVISION Pst�r— ocz.P LOT #
System Installer: S F.a Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
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.
This system has been installed in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement rermir ana Lonstrucnon aumonzanon.
PERMIT CONDITIONS:
1. 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 ❑ NA
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 s stem on the above aptione operty.
Type of system: ❑ Conventional tP Other rc'� �1 �� Septic Tank: '1 (50 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch- S of each ditch , 8 feet ditches feet ditches ci�� j—�i inches
French Drain Required: lineet
Authorized State Agent ��``�. ��.`\ Date