OPHTE# /3- 3 /J�`�� Harnett County Department of Public Health
PERMIT # c2:?'?j`�S' Operation Permit 22935
Cr New Installation ❑ Septic Tank Ci' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Name: (owner) (owner) ze /? ;l%: i SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Ii
Type of Water Supply: ❑ Community Z'�Public ❑ Well Distance from well feet
System Type: LZ'b 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.
Ims system has been installed In Compliance with applicable north larolma General Statutes, Hules for SewaRe Ireatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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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 ❑ 112O1-ine ❑ PWR Line
Following are the spe ' lcations for the sewage disposal system on the above captioned property.
Type of system: conventional ❑ Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of j exact length width of depth of
Drainage Field ditches / of each ditch U v feet ditches 3 feet ditches 3o ° inches
French Drain Required: Linear feet
[Authorized State Agenz ,�_ _ �� �N�1 Date �% I ( ► 2-6 i �7
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