OPHTE# %N 75-~~_~TiL~ Harnett County Department of Public Health
PERMIT # 2~,b_l VLA Operation Permit 2 2 0 3 2
New Installation .'!I\ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cec~~ ~z,G c,
Name: (owner)SUBDIVISION - LOT #
System Installer: 1--c-ANNC o-\-N~As 0 ~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well KM.- feet
System Type: 1 1 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.
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other E7 FjXvj Septic Tank: 10<_)C) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ect ach ditch 1 -:15 feet ditches- feet ditches inches
French Drain Required: et
Authorized State pent Date t6
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