OPHTE# \3 -5- Harnett County Department of Public Health
PERMIT #�a-� Operation Permit 22862
New Installation � Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: D acrs CD
Name: (owner) t—�. EE. �� y t�Gs SUBDIVISION C)P0LrNo to LOT # 111
System Installer: Ca Registration #
Basement with plumbing: ❑ Garage "C Number of Bedrooms t'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 0 C) 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 peen installed in compliance with appucame North t.arouna uenerai xatutes, Wes for sewage ireatment and Disposal, and all conditions of the
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PERMIT CUNDIIIONS:
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:
Permit and Construction Authorization.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above roperty.
Type of system: ❑
Conventional
Other Septic Tank: 1 ® ®(3
gallons Pump Tank: gallons
Subsurface
of
exact length width of
depth of
Drainage Field
ditches
of each ditch 3 O feet ditches
feet ditches 3 C —) inches
French Drain Required:
neafifeet
Authorized State Agent N�"�� R�_ )5 Date 5
13-5- - )51 C