OP RHTE# 07-5 -/8/3R,7_ Harnett County Department of Public Health 19843
PERMIT # 1 Y1 Operation Per it _f
New lation l[] Septic Tank ❑ Repair 2 Nitrification Line ❑ Expansion
PROPERTY 104KI7cB /Z~)
Name: (owner) SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing. ❑ Garage her of Bedrooms
Type of Water Supply: ❑ Community 5~Pbli( ❑ Well Distance from well feet
System Type: t2 rz Types V and VI Systems expire in 5 ye
(In accordance with Table Y a) 'Owner,mu t c a H alprartment 6 months prior to expira for permit renewal.
This system has been installed in compliance with applicable Marth Carokna Statu A condition of die Im oremmt ennit and (onsmkdon Audmintion.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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:
V. Other.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Size of tank: Septic Tank: / t)6o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /UV feet ditches 3 feet ditches 1 Z- LN -l2. inches
french Drain Required: Linear feet
Authorized State n ~v Date 1 " 1 g'D