OPHTE# 1a-5,Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 4 4 3
X New Installation X Septic Tank ""K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Vw'e Q-P
Name: (owner) Sp.v-4-) LL C- SUBDIVISION LOT # 1q
System Installer: ViP,Q oN A 51-~Q> > 5- Registration #
Basement with plumbing: ❑ Garage 'K Number of Bedrooms L4
Type of Water Supply: ❑ Community-.,a_3X Public El Well Distance from well MQ feet
System Type: c 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: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
IV. Operation:
V. Other:
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1120Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other S-Z_ -aW Septic Tank: )1®®d gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: oat,
Authorized State Agent Date t
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