OPHTE# ra= 5-._�O'*",+- Harnett County Department of Public Health
PERMIT # `�� S 3 Operation Permit 22810
New Installation.] Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: m :
Name: (owner) CvynaF2c -e',19 V)OmG5 e- SUBDIVISION 'n e�rz) t.Q LOT # r.
System Installer: aw ij Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 ®d 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.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation cc
maintenance and reporting.
V. Other:
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p, \:s Loc ,T 4TJ +.r �P,O o P E
y-
¢.ta �N Ac c r ism
❑
D -Box ❑
Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the jib ca one property.
Type of system:
El Conventional
®ove
Other �t�Sa FCZ— Q�
Septic Tank:
i0 ®0 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches '
of each ditch ®a feet
ditches
3 feet ditches inches
French Drain Required: Linear teet
Authorized State Agent_ Date
��� s�30�.� �