OPHTE# l~'0 Harnett County Department of Public Health 19900
PERMIT # y 3~ Operation Permit
New Installation J JS Septic Tank ❑ Repair"K Nitrification Line ❑ Expansion
Name: (owner) PROPERTY LOCATION:_ ;ti !It-(
.'/.5-/
-LOT # /
System Installer. _ C '~c SUBDIVISION Registration # ? L
Basement with plumbing ❑ Garage Number of Bedrooms L_(
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 5-0,
feet
System Type: -1n P_ ) - t. V C.{ 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.
ITSIM nu MM IMUM0 m cornpg o with ~p4c~
Nod (wofina Gen" Smwtm Wks for Sewage Trewnent and
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PERMIT CONDIT1019•
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No '19
If yes, see attached sheet for additional operation co
IV. Operation:
V. Other.
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other .c Size of tank: Septic Tank: ~a
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: linear Feet
Authorized State Agent
VA aA conditions of dk knprowement Permit and fomhuction Autimna m
Date t V