OPNTE#C)'~ Harnett County Department of Public Health 21 3 5 0
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair jX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Iy C,'a0 %,,.I
Name: (owner) avMg tu.~•a `Ao~.t;~ N c, SUBDIVISION Msctn. LOT # -~j_
System Installer: `T E<, 4~ow Registration #
Basement with plumbing: ❑ Garage `,e Number of Bedrooms -
Type of Water Supply: ❑ Community '19, Public ❑ Well Distance from well )b0 feet
System Type: 77;;~ Types V and VI Systems expire in 5 years.
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(In accordance with Table V a) Owner must contact-Health Department 6 months prior to expiration for permit renewal.
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qi y v e .,,g- L- C."§Y-nA -2 Septic Tank: l C'5 b 'U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches _ inches
French Drain Reauired: i;„~feo. _
Authorized State Agent
Date
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