OPHTE# 0°)-5-Z6a'+a Harnett County Department of Public Health 21 0 91
PERMIT #Operation Permit
X New Installation ~kq Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: WALL L-uc~a~ Q,p
Name: (owner) Rte. .tom ~-oa r: SUBDIVISION C t Qz Li,-4 a C~ a s LOT # 57
System Installer: S S V-e- v C- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L'}
Type of Water Supply: ❑ Com-,m~anity~ Public ❑ Well Distance from well X00 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.
1. Performance:
If. 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 ❑ N
If yes, see attached sheet for additional operation cc
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: A Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches - of each ditch 3a0d feet
French Drain Required: ~lr~c feet
Septic Tank: 1006 gallons Pump Tank: gallons
width of depth of
ditches -3 feet ditches 1q inches
Authorized State Agent R.~-A S Date 1
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