OP RHTE# /0-~ =a7 -7 9se Harnett county Department of Public Health
21286
PERMIT # as7aV Operation Permit
New Installation V Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Ck,^:J'1.~~~
Name: (owner) CaA-. f ~-Ow-J-IAf~ ~~~J~•ef SUBDIVISION n-,g, (I LOT # f
System Installer. 4-AA V Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms J
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 717- 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.
IV. Operation:
V. Other.
following are the specifications for the sews disposal system on the abo captiogqed property.
Type of system: ❑ Conventional Other Q, ,c k 5o 4-95.- Septic Tank: <)~-o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3607 feet ditches 3 feet ditches /Go inches
French Drain Required: Linear feet
Date /1'11 1. Performance: System shall perform in accordance with Rule .1961.
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Authorized State Agen "
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 reoortinv.
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