OPHTE #—`� Harnett County Department of Public Health
PERMIT # �~�% ��—� OlDeration Permit 22883
New Installation IX Septic Tank Nitrification- Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PO %-?> z-Q A fl
Name: (owner) C.., 0MC,5 SUBDIVISION C'AAgo1 -Nr•t LOT # 14
System Installer: X- v,3 E5 Epp zNL Ssry t c�s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1.04 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
with applicable North Larohna benerai Statutes, Rules for Sewage Ireatment and Ulsposal, and all conditions of the
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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:
Permit and Lonstruction Authorization.
V. Other: Q\ ,,aUa , K s Sum NC,GN; .
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal �sXstem on the above aptioned-R roperty.
Type of system: ❑ Conventional Other Septic Tank: 1140 gallons Pump Tank: gallons
Subsurface exact length width of depth of
Drainage Field di ches �� each ditch t Sd feet ditches feet ditches a�`" 10 inches
French Drain Reauired:� \`�
Authorized State Agent -� ®�______ ���"I --,-k\ Date
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