OPHTE# r = Harnett County Department of Public Health
PERMIT Operation Permit 2 2 0 7 4
2 New Installation Ed Septic Tank "itri6cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: le,l y 3 Ao4"
Name: (owner) .S941j! )3V4Cr//7~~ ° oz SUBDIVISION 1o ,z 4V -LOT #
System Installer: Registration #
Basement with plumbing: C' Garage er of Bedrooms
Type of Water Supply: ❑ Community r El Well Distance from well feet
System Type: 25'1,a ® I a & I1l, Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner st contact Health Department 6 months prior to expir o ermit renewal.
3 Y ~,t~
This system has been installed in complian ith appl le j"rth Carolina General Statutes, Rules of r $ewaage TTFatm itions of the Improvem t ermi ;Cons[ true on Auth rization.
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property. V'pl
Type of system: ❑ Conventional Other Septic Tank: / f gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch d Zo feet ditches -3 feet ditches !y inches
French Drain Required: Linear feet
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Authorized State / / Date /y - f1'
'H S l l
4r
11-5-26845 (1)
11-5-26845 (2)
11-5-26845 (3)
11-5-26845 (4)
11-5-26845 (5)
11-5-26845 (6)
11-5-26845 (7)
11-5-26845 (8)
11-5-26845 (9)
11-5-26845 (10)
11-5-26845 (11)