OPHTE# Sc-).- -'?�` Harnett County Department of Public Health
PERMIT #�3� Operation Permit 22626
New Installation X Septic Tank Nitrification Line ❑ Repair F-1 Expansion
PROPERTY LOfATION: M P�czs
Name: (owner) 9 X14 j=sja C. ��° a • SUBDIVISION P.6'v4 ey egp LOT # 1
System Installer: o rs Registration #
Basement with plumbing: ❑ Garage"V Number of Bedrooms t— t
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I bO 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.
ims system nas oeen mstauea in compuance wim appucaoie Nortn Larohna uenerai statutes, ewes for sewage ereatment ana uisposai, ana an conmNons of the Improvement rermit and lonstruction Authorization.
PLKMII CUNDIIIUNS:
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` I
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 captio�ed property.
Type of system: ❑ Conventional A Other Septic Tank: tOOO gallons Pump Tank: gallons
Subsurface No ,of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Q,I-k-30 inches
French Drain Required: bqgkr feet
Authorized State Agent ' Date �)31)3
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