OPH T E �'_'S6 Harnett County Department of Public Health
PERMIT # l� l-7 Operation Permit 22795
New Installation 1K Septic Tank b< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) � ���►�' NkoMGS SUBDIVISION 1��fa� �u �'AS LOT # 4
System Installer: NgNwa,s E.9"'Nc. Registration #
Basement with plumbing: ❑ Garage "1 Number of Bedrooms _ 1-�_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well f-bb 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 ueen mstaueo in compuance wim appncame norm carmma oenerat xatutes, Wes for sewage treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
I-
rtKMIl LUIIUIIIU143:
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 ❑
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'X Other E—z Via Septic Tank:
Subsurface No. of exact length width of
Drainage Field es of each ditch O feet ditches _
French Drain Reauired: feet
H2OLine ❑ PWR Line
0 0 00 gallons Pump Tank: gallons
depth of
feet ditches -AO -30 inches
Authorized State Agent �e >'' Date