OPHTE# Harnett County Department of Public Health
PERMIT # �� � Operation Permit 23316
New Installation X SA'Nitrification Line ❑ Repair ❑ Expansion
l � PROPERTY LOCATION:
Name: (owner) `c`tr►�p� y�,�, c� �, �N c. SUBDIVISION i LOT # aS J
System Installer:a Q� v Fit. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community "�( Public ❑ Well Distance from well �C% ® feet
System Type: > 1 IN Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional I Other t u Septic Tank: 100 Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch I feet ditches c�
feet ditches inches
French Drain Required: •� �.. o�^ra .Eoor
Authorized State Agent \� ������.� 5.JC'N a1 Date -i1 '::It I it'1
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