OPHTE# i �-- t;_ - z °76P o Harnett County Department of Public Health
PERMIT # Operation Permit 22490
CT New Installation Septic Tank L"Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5g jqt 3 %c«
Name: (owner) '9NZ11 3U2 D FYZ- 1. y% SUBDIVISION LOT # 83
System Installer: A Eli Z_ Registration #
Basement with plumbing: ❑ Garage Z" umber of Bedrooms 3
Type of Water Supply: ❑ Community L+1 Public ❑ Well Distance from well feet
System Type: r . 4-0 2-a'C, s 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 above captioned property.
Type of system: ❑ Conventional 11 Other LSD ® 52 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 60 feet ditches feet ditches 22 inches
French Drain Required: Linear feet
Authorized State het Date 2- - 11 13
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