OPHTE# 09' Harnett County Department of Public Health
20979
PERMIT # Operation Permit
New Installation jam-Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~~nd cr~o Ind
Name: (owner) Ccn n~~,~- f~ SUBDIVISION C'~ LOT #
System Installer: 77 aeLo-N ~ ^ Registration #
Basement with plumbing: ❑ Garage J4J Number of Bedrooms 1"f
Type of Water Sup I : ❑ Community 5( Public ❑ Well Distance from well -03 feet
System Type: , a b y -55r?~ 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.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No(P-
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew a disposal syjmr on the above captioned property.
Type of system: ❑ Conventional Other hX i tSeptic Tank ~ J
Subsurface No. of -~s_ gallons Pump Tank: gallons
exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent a_ - Date - - t
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