OPHTE# 'li- z.' Harnett County Department of Public Health
PERMIT # - Operation Permit 2 2 2 5 3
® New Installation 2~ Septic Tank ff Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: z1t3 rZ,3,41
Name: (owner) k~ SUBDIVISION LOT #
System Installer: ;;6" Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community L1if Public ❑ Well Distance from well feet
System Type: Z" 1)i/L -ZI-6' 0Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ac ea don for permit renewal.
This system has been installed in compliance with applicable Norlih Carolina General Statutes, Rules for
and all conditions of the
Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961. J,
ll. 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:
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V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the aboove^ca~tioned roperty,, 'ZUIJ
Type of system: El Conventional [if Other 24;'. il=l S p is Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch feet ditches .3 feet ditches inches
French Drain Reouired: Linear feet
Authorized State tent Date 1 L