OPHTE# ,b -Harnett County Department of Public Health 2 0 9 7 6
PERMIT # C Operation Permit
New Installation~Septic Tank ❑ Repair A, Nitrification Line ❑ Expansion
PROPERTY LO TfA ION: SR j k ~
Name: (owner) C0^Y SUBDIVISION V,C' e I rye r LOT # 7
System Installer. L -K A, fr. Registration #
Basement with plumbing: ❑ Garage A Number of Bedrooms
Type of Water Supply: Community "~C Public ❑ Well Distance from well 10Z) feet ~a
System Type: t + r?C < 5 1 Types V and VI Systems expire in 5 years.
(In accordance with table Y a) ~ O;
ner must contact Health Department 6 months prior to expiration for permit renel.
V. Other.
Following are the specifications for the sewage disposal Tae on the above captioned property.
Type of system: ❑ Conventional Other Tae cj, r Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch - feet ditches feet ditches U~ inches
French Drain Required: f Linear feet
Authorized State Agent = -YAI) Date DI "
C
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
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