OPHTE# 1r1�,- 5 -3cJS ")l Harnett County Department of Public Health
PERMIT # X -12�_1-3 Operation Permit 22864
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Q0c,5'?
Name: (owner) c� E �0 c-'\ lE_5 SUBDIVISION 0 AKc�o � � LOT # 11�3
System Installer: c.. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S C_9:�) 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.
finis system nas peen instanea in compuance wan appocaoie noun Lamina t,eneraf xatutes, Rules for Sewage treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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rcrimi LvNulffun):
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 ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abov captione roperty.
Type of system: El
Conventional X, Other C)A �,w NB ���'` Septic Tank: 1 d d d
w
gallons Pump Tank: gallons
Subsurface
N 0- of exact length width of
depth of
Drainage Field ditches of each ditch �O feet ditches 3
French Drain Required: �linea t
feet ditches S6° �� inches
Authorized State Agent �\ \\ \�\��\�\ _ 2%�L� Date 5
B-r S- sal