OP RHTE#M Harnett County Department of Public Health
21116
PERMIT # Operation Permit
New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Ss~at, Mooaa
Name: (owner) .c .a gu La-c>(,\L DUX t-cJ6'i5 \Nc' SUBDIVISION Qv P,k ~oL-i.ov,j LOT # A_
System Installer: ~Ay Ac Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: El Community ❑ Public Well Distance from well 5d 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.
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1. Performance:
11. 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
FacpA~5 t~ r OF E ss <s~s C Svs~-F~n
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches - of each ditch 80 feet
French Drain Reauired: _ -'tiupar`fw
wan applicable north Larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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Septic Tank: Ek r- "V'l r, gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent \11, ~ ~ Date fa`~A