OP RNTE #�Z z��z�, Harnett County Department of Public Health
PERMIT # Z7Z-11 Operation Permit 22482
New Installation ff' Septic Tank ❑" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 1311,ng �� ?w�- SUBDIVISION lll ar LOT #_
System Installer: Registration #
Basement with plumbing: ❑ Garage Vpublic umber of Bedrooms 3
Type of Water Supply: El Community ❑ Well Distance from well feet
System Type: L!& tZO K'J —Z0-)� , ' 'Ze (9 r 2 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mus contact Health Department 6 months prior to expiration for permit renewal.
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I. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other 250% Z! ;)Uf.r y Septic Tank: /6.41 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch `O7 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Date Z
Authorized State ARgnt �cdj