OPHTE# t1- 5- `�DL"1MI Harnett County Department of Public Health
PERMIT # 3-f6gS5 Operation Permit 22770
New Installation V Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M +c uoow�sz
Name: (owner) SUBDIVISION I LOT #
System Installer: ` o Registration #
Basement with plumbing: ❑ Garaged Number of Bedrooms 3
Type of Water Supply: ❑ Community 'i;j Public ❑ Well Distance from well 000 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtKNl I IUNUII IUN):
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 x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the a°ve captioRd property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch No feet ditches feet ditches 2k4 34 inches
French Drain Reauired:c --, ti r feet
Authorized State Agent x- \5 Date ti
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