OP RHTE# Harnett County Department of Public Health 19926
PERMIT # Operation Permit
New Installation X1 Septic Tank ❑ Repair'X Nitrification Line ❑ Expansion
PROPERTY LOCATION: L-~MUGt `~LPc~- 9,
_
Name: (owner) SUBDIVISION LOT
System Installer. _ CNo_or.,,P,t, C., I V.,, Registration #
Basement with plumbing. ❑ Garage )K Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well sa CD feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) v Owner must contact Health Department 6 months prior to expiration for permit renewal.
IN system has ?ken imtakd in conova with applicable North (Sohn General Statutes, Rules for Sewage Treatment and OisposA and all mididam of the Improvement Permit and fommtction Authorization.
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1. Performance:
II. Monitoring:
ill. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ Nom
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the sewage disposal system on the above motioned property.
Type of system: ❑ Conventional X Other PoLy?cygE r ~~e. 1~,,c Size of tank: Septic Tank ~000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch a~0 feet ditches 3 feet ditches I~ inches
French Drain Reauired: _ Lineardeer
Authorized State Agentt y Ps Date I ~a9~o~