OPHTE# //- r- //J— Harnett County Department of Public Health
PERMIT # Operation Permit 22598
C' New Installation Eg"Septic Tank ELK— Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: q21
Name: (owner) a 1G kz,, %:14, SUBDIVISION LOT # f
System Installer: nom: r /1e44.-, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community 2'-Public ❑ Well Distance from well feet
System Type: Zy— 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 nas ueen mstanea in compuance wim appucaoie norm t.aronna ueneraT xatutes, tomes for sewage Treatment and uisposal, 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispose system on the above captioned property. Q
Type of system: ❑ Conventional E Other j'Q� l Septic Tank: �_ gallons Pump Tank: P00 6 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch o2% O feet ditches 3 feet ditches o?0 inches
French Drain Required: Linear feet
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Authorized State Agent � -�;w -- G ����� Date
11-5-- �-7 r /s'