OPHTE# l3._5- -31Q -D Harnett County Department of Public Health
PERMIT Operation Permit 22898
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Y Ho SUBDIVISION 5 )`1z.4"S 50L.I LOT # al
System Installer: r Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1%U 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:
1. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
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❑
D -Box ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional Other
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Septic Tank:
100 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 Require : in
Authorized State Agents Date °l 3
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