OP RHTE# J Harnett County Department of Public Health
PERMIT # Operation Permit 22884
, I New Installation >� Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) PAS? C-0 v,11. y )--
System Installer: 1s_�- T,�� -���CZ
Basement with plumbing: ❑ Garage )< Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: PJC.r -
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SUBDIVISION —1 Vol LOT # I 1
Registration #
Distance from well 152)® feet
Types V and VI Systems expire in 5 years.
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.
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:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: t G gallons Pump Tank: 1000 gallons
Subsurface N0. 0 exact length width of depth of
Drainage Field ditches of each ditch �O feet ditches feet ditches S� "�� inches
French Drain Reauire��. \
Authorized State Agent �y� ��`������ Date '2 1�� �3
tC�> -- E) ^'3 0-1 �6a,