OPHTE # - -'iC �r Harnett County Department of Public Health
PERMIT # Z15�i- y , Operation Permit 23006
EKNew Installation (Septic Tank 21itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) _ / -s -� SUBDIVISION f- LOT # _j__
System Installer: 6 ..e,,>- 5-772, 2jt./,,'Y) Registration #
Basement with plumbing: ❑ Garaged umber of Bedrooms_
Type of Water Supply: El Community L''J Public ❑ Well Distance from well feet
System Type: 0 6Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) must c ntact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North CarolinT-Ggneral 5hhaes, Rules
Treatment and Dispo all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .19
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required b Rule r:
su ace 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewap disposal system on the above captioned property.
Type of system: ❑ Conventional Eir Other Septic Tank: 2"�C% gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 10 V feet ditches feet ditches 21 inches
French Drain Required: Linear feet
Authorized State A tie t � 1�m Date 1l o 3