OP RHTE# 1Z'_ -���z Harnett County Department of Public Health
PERMIT # 4'70113 / OOperation Permit 22975
C/ NeW Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION i4c
Name: (owner) 5 C-1-i 5 J?-V— SUBDIVISION LOT # 4Z
System Installer: ' � 4A-, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 7r Public ❑ Well Distance from well feet
System Type: 2 t T es V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT ff)NnITIONC-
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Ed Other �S4 /bt��3 5415 a Septic Tank: gallons Pump Tank: t � gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 7�" feet ditches -3 feet ditches �Z � � �a inches
French Drain Reauired: Linear feet
Authorized State he
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