OPHTE# V��5 a�a0 Harnett County Department of Public Health
PERMIT # Operation Permit 22631
New Installation Septic_ Tank( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a
Name: (owner) 0,A oN SUBDIVISION 'sue (X--j Yo s,Y–, E, LOT # P),
System Installer:�N--�, t) `3 r\ t\ f -N �— Registration #
Basement with plumbing: ❑ Garagelx Number of Bedrooms —�)
Type of Water Supply: ❑ Community_ _�` Public ❑ Well Distance from well 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.
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CONDITIM-
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
wan appucame norm Larolma general statutes, Wes for sewage treatment and
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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.
Permit and Construction Authorization.
❑ 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 a.-Z, V---o Septic Tank: }()C(--) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches L— inches
French Drain Required: vLin&-feet
Authorized State Agent �� J7�,&x -\ Date al I