OPHTE Harnett County Department of Public Health
PERMIT # z.� Operation Permit 22819
New Installation 'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: hoc,
Name: (owner) cX4-- , �'lOcnC 5 SUBDIVISION Q) o LOT #
System Installer: Eo s)-N z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well t b4 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.
mis system nas peen mstauea in compuance win appucame norm taronna eenerai xatures, rcuies or a e treatment ana
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other:
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an conamons of me
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captione roperty.
Type of system: ❑ Conventional Other C. -NP -84 M Septic Tank: 100
Subsurface No. of exact length width of
Drainage Field ditches of each ditch feet ditches
rermit ana Lonstrucnon autnonzatton.
H2OLine ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches 1.8 inches
French Drain Required: i ar
Authorized State Agent Date )N3�