OPHTE# 015JJ $ S ~1 Harnett County Department of Public Health 19896
PERMIT # QA a e ( Operation Permit
New Installation ❑ Septic Tank ❑ Repair ❑ Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION G/sr LOT # F-3
System Installer: Lea Registration #
Basement with plumbing. ❑ rage 0- Number of Bedrooms -3 -
Type of Water Supply. ❑ Community `40 Public ❑ Well ce from well S ~ feet
System Type: > C C-' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner ust contact Health Department 6 months prior to expiration for permit renewal.
INS system rus been "staled m conpfmce with amca* Norris C"na Gels" Stawtes, nubs for kwa e_TWMWt ud DisptrA and aM caditiom of die bnpr MM Permit. ud Comes OM Authoiaubm
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PERMIT CONDITIOK
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IY. Operation:
Y. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional "er ft, Size of tank: Septic Tank: 00 o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch ~J feet ditches feet ditches -LX- 2-'( inches
French Drain Required: Linear feet
Authorized State Agent r~ Date - ~2
71