OPHTE# � Harnett County Department of Public Health
PERMIT #tea Operation Permit 22622
New Installation _-M Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:`""l
Name: (owner) wl SUBDIVISION i,-, .,l LOT # Y
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ! c d feet
System Type: a, Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 'O Owner must contact Health Department 6 months prior to expiration for permit renewal.
,ms system nas peen instanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1 L111111 LVIIVIIIVII).
I. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Ems. Septic Tank: tOOo gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ���,,,_Linear of each ditch 01oC3 feet ditches feet ditches �° O inches
French Drain Required: feet
Authorized State Agent � ., 5 Date