OPHTE #lam 3' DD- S Harnett County Department of Public Health
PERMIT # � Operation Permit 22832
Dk New Installation 'R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I") elc �-,>
Name: (owner) SUBDIVISION LOT # S 6
System Installer: Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well MV feet
System Type: 1 h 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.
Ihis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
renrtti Lvtrvntvns:
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other: V. * ••
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
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Type of system: Conventional Other P ^�
U Cn4 50 �..,VN" ,m ltat'+ J Septic Tank: to ® 0 gallons Pump Tank: 1®Q Q gallons
Subsurface_..,,_ No. of exact length width of ,-S depth of
Drainage Field ditches - - -1 h ditch 4 feet ditches feet ditches —3l) inches
French Drain Reauired Z �
Authorized State Agent '�`�� `� \�� \_®`'`.,C� Date r-
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