OP RHTE#07-s' Harnett County Department of Public Health
PERMIT 0 eration Punt 22051
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V,,1463
Name: (owner)( A -,,~p SUBDIVISION LOT # S3
_
System Installer: - i Registration #
Basement with plumbing: ❑ Garage & Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 6¢12 t AF_ "Y'Zoa-*M79 07Z L 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.
[his system has been installed in compliance with applicable North larohna beneral )tatutes, Rules for )ewage treatment and
and all conditions of the improvement rermtt and Lonstructton nutnortzatton.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Ed- Other es"On, Se tic Tank: /OOC) gallons Pump Tank: e) gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ` of each ditch ~0 feet ditches 3 feet ditches _)/0 inches
French Drain Required: Linear feet
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Authorized State A Date M'
07-5-17565R (6) 07-5-17565R (7)