OPHTE# % Harnett County Department of Public Health
PERMIT # "11% Operation Permit 22785
�l New Installation '�Q Septic Tank X Nitrification Line ❑ Repair ❑ €xpansior
PROPERTY LOCATION:
Name: (owner) 16 N C — �A o m SUBDIVISION R, LOT # '-\f-
System Installer: _Zo -N c.5 \c- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t 130 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 system nas peen mstauea in
wim appocame norm Laroona uenerai matutes, nudes for sewage treatment ana
ana an conamons of me improvement rermit ana s.onstrucnon aumoraanon,
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PERMIT CONDITIONS:
1. 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 ❑
Following are the specifications for the sewage disposal s stem on the above ca tinned property.
Type of system: ❑ Conventional Other EAR &CQ�� Septic Tank: d00O
Subsurface No. of exact length width of
Drainage Field itches L of each ditch feet ditches
French Drain Required:
Authorized State Agent es-A,�5 Date
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
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