OPHTE # Harnett County Department of Public Health
PERMIT # S
Name: (owner) C , vyU
System Installer: Cm g 5
Basement with plumbing: ❑ Garage Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well
System Type:
(In accordance with Table V a)
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PERMIT romnlTinkic•
Operation Permit 22620
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : �A
SUBDIVISION l t�as�n, ,,;` LOT # 132.
Registration #
Distance from well 00 feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
with applicable north carolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. 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 ❑ No x
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 -Z—
Septic Tank: i gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
French Drain Reauired:
of each ditch 121,0 feet
ditches feet ditches inches
Authorized State Agent J --'.1 y _ 9L mss Date