OPHTE# 13— `J . Harnett County Department of Public Health
PERMIT # Operation Permit 22886
New Installation Septic Tank °, Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -`?o �,,D Q.,o
Name: (owner) SUBDIVISION LOT # a0
System Installer: 1 w Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t O Ci 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.
Ina system has been mstaltea in compliance with applicable North Larolma beneral Statutes, Rules for Sewage Treatment and
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and all conditions of the
ritnrnl LUNUIUUNY
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system:, El Conventional
Subsurface of
Drainage Field ditches
French Drain Required:
Permit and construction Authorization.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the above capti d property.
Other CAN-6642_ Septic Tank: V50 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch O feet ditches 3> feet ditches inches
Linear feet
Authorized State Agent s Date
1 -Sr x--30 � lll�l