OPHTE# 13_5 °3o9aD, Harnett County Department of Public Health
PERMIT Operation Permit 22801
New Installation Se tic Tank, Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: m'S it N%r Ut-,
Name: (owner) SUBDIVISION LOT #
System Installer: ko SJ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community ❑ Public "N( Well Distance from well 0 feet
System Type: T_T' I 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
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PERMIT CONDITIONS:
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 abe� cap ed property.
Type of system: ❑ Conventional Other Cr1P�m��SL'��i2`'`_ Septic Tank: X044 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ---ditrbts of each ditch 141) feet ditches feet ditches I0C inches
French Drain Required: _ near feet
Authorized State Agent Date
I - 5 - 1 01 �1�1