OP RHTE#0-L- 00- wo a Harnett County Department of Public Health 19907
PERMIT # L 1, 2 Operation Permit
`V"ew Installation->5-Septic Tank ❑ Repaid Nitrification Line ❑ Expansion
PROPERTY LOCATION: N'- "2'7
Name: (owner) U-1 A /1 Cow' SUBDIVISION %i W LOT # 2
System Installer. c~o Lf L-4 C-1 k Registration # `f -I-
Basement with plumbing ❑ arage JZ---Number of Bedrooms
Type of Water Sup ❑ fommunity Public ❑ Well Distance from well _j feet
System Type: 2 Er I J L1 - -=f/ 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.
in" s nu oeen mstWa m compemce with North Cxo6na Gtmeral Shwtes, Ruks for Sew ireument Xd Di W AN conditiostt of dse h rorement Permit and Cmswetion A Amu iw
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Prnmrr rnYAR1AW.
1. Performance:
II. Monitoring
III, Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 9
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew disposal sys t on the ore captioned property.
Type of system: ❑ (onventional Other u Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of ii exact length width of G~ depth of
Drainage field ditches l of each ditch ? feet ditches feet ditches f D a ` inrhes
-r- -
french ram gwre : linear feet
Authorized State Agent Date J '