OPHTE# t3 -5 3C839 Harnett County Department of Public Health
PERMIT J32— Operation Permit 22570
0 New Installation 2"'Septic Tank �— Nit^rifi�ation Line El Repair El Expansion
PROPERTY LOCATION: M f . �,15 ak Ck, --k /?4
Name: (owner) �e. `/�e�,r� —r SUBDIVISION > LOT # %
System Installer: /y1o� (y T�rt< �-� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Z' Public E?'-Well Distance from well loo feet
System Type: .��G 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.
this system has been installed in
PERMIT CONDITIONS:
with applicable North larohna General )tatute5, nines for )ewage Treatment and usposal, and all conditions of the
Ste"
7 v
S' I', S-S
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewa ,V disposal system on the above captioned property.
Type of system: ❑ Conventional EZ Other
Subsurface No. of exact length
Drainage Field ditches C�, of each ditch g feet
Alarm ❑
rermlt and lonstructlon Authorization.
e IJ
1 19
Y
H2O1.ine ❑
PWR Line
Septic Tank: /QOM gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent `'' !' 6- d r Date
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