OPHTE#IG((jGI Harnett County Department of Public Health
20547
PERMIT # a.4-7~-~ Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:_H
Name: (owner) -,S0'Z Z~. 201 ,i- SUBDIVISION LOT #
System Installer: Ls',2Q--. s-j f~17,P G- Registration #
Basement with plumbing: ❑ Garage ❑ Nmrr6"44e4mm r , ,n as,, Glua,G,9
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well k C) b feet
System Type: 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.
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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. `-~vct~~y L~wE 3C" 0
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other 1 s Q_G Ga Ne~ Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch CO feet ditches 3 feet ditches a"
French Drain Reauired:- n..,
gallons
inches
Authorized State Agent_ Date 411,316
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