OP RHTE# oC:A Harnett County Department of Public Health 21268
PERMIT # Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Uwyr~,7\-j
Name: (owner) P~.r,F11•L a vs ~p,~,~,,, H SUBDIVISION l ►~,~E~ Po, -M LOT # 'I`$
System Installer: c" Ka t_t.ra~D Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tOc feet
System Type: _--,a 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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wan aWicame norm t,arolina (ieneral Statutes, Rules for Sewage Treatment and
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and all conditions of the
Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. Wn„C,2t_,,,¢ UN0M Svpoa, L-~uE
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Pu mQ -1T J.Z FrL Septic Tank: 1 OQ)o gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches \ of each ditch 2,30 feet ditches 3 feet ditches 1'2 inches
French Drain Requi e . inear feet
Authorized State Agent y QEN Date ~o