OPHTE# Harnett County Department of Public Health
PERMIT # Z 17 Operation Permit 22694
C�New Installation eptic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ft °°° a 2474,% aeyO
Name: (owner) SUB
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DIVISION % LOT #
s
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: 2�°� w =ust Types V an d VI Systems expire in 5 years.
(In accordance with Table V a) Ownntact Health Department 6 months prior to expiration for permit renewal.
PERMIT COND111UNS:
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:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
❑ D -Box ❑ p
Following are the specifications for the sewa a disposal system on the above captioned property. Septic Tank: gallons Pump Tank: gallons
Type of system: ❑ Conventional Other Z'� %s i46 width of depth of
Subsurface No. of exact length
Drainage Field ditches
Z of each ditch / 2D feet ditches feet ditches Z inches
French Drain Required: Linear feet
�P` l Date
Authorized State AR at � y ��
11 -5 -25889 (1) 11 -5 -25889 (2) 11 -5 -25889 (3) 11 -5 -25889 (4) 11 -5 -25889 (5)
11 -5 -25889 (6) 11 -5 -25889 (7) 11 -5 -25889 (8)