OPHTE# t�_- s"-3a333 Harnett County Department of Public Health
PERMIT # Operation Permit 22558
New Installation C�Septic Tank V_ Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) A11r;A 5 e��f -nom SUBDIVISION 196 LOT #
System Installer: 2) `, ) . ljr-, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Z' Public ❑ Well Distance from well feet
System Type: 7747& 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.
Ihls system has been installed in
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
with applicable North Larolina beneral )tatutes, Rules tar )ewage treatment and uispos�
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and all conditions of the
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
rermrt and Lonstruction Authorization.
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V. Other.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewafie disposal
system o the above captioned property.
Type of system:
11 Conventional Other
C2G7 0-) Septic Tank: `000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch ) O 0 feet ditches 3
feet ditches Al inches
French Drain Required: Linear feet
Authorized State Agent Date 2 s_" /° J"7 Q_�2
3u7") ,�