OPHTE# L' ° Harnett County Department of Public Health
PERMIT # 7--1Z -3 q Operation Permit 22677
L New Installation Septic Tank ❑- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS ig-71 ;
Name: (owner) � , SUBDIVISION LOT #
System Installer: Z— Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well feet
System Type: 257n s V and VI Systems expire in 5 years.
(In accordance with Table V a) j Owner must cont ct Heath Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length _ width of depth of
Drainage Field ditches L of each ditch feet ditches - feet ditches ) ` inches
French Drain Required: Linear feet
Authorized State Age Date t
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12 -5 -30219 (1)
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12-5-30219(11)
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12-5-30219(16)
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12-5-30219(19)
12-5-30219(20)