OPHTE # /3T S,OS 'i7 Harnett County Department of Public Health
PERMIT # 27378 Operation Permit 22679
_/ New Installation�c Tank
E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ' tea
Name: (owner) ,16�/&'� 4 SUBDIVISION LOT #
System Installer: P Registration #
Basement with plumbing: ❑ Garage EtNumber of Bedrooms 3
Type of Water Supply: ❑ Community 2""Public ❑ Well Distance from well feet
System Type: 2 rN— Jt, `r es V and VI Systems expire in 5 years.
(In accordance with Table V a),.ti Owner must contact Health Department 6 months prior to expiration for permit renewal.
rtm•ni Lvnunivn3:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ _ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionLpro%pe"," Ty pe of system: ❑ Conventional ❑'Other 25"fot ' Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State nt Date L
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