OPHTE# ,3 -i �� Harnett County Department of Public Health
PERMIT # L ?N 76, Operation Permit
2-"'Nitrification 22996
New Installation Z Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 40
Name: (owner) SUBDIVISION _ � 0 � � LOT # Z
System Installer: `` Registration #
Basement with plumbing: ❑ Garage [ ,,Mumber of Bedrooms ..5
Type of Water Supply: ❑ Community Ir Public ❑ Well Distance from well feet
System Type: A Types V and VI Systems expire in S years.
(In accordance with able 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew 3K disposal system on the above captioned property .
Type of system: ❑ Conventional Z Other %5':Yp iIA-D � Tank: gallons Pump Tank: gallons
Subsurface No. of exact length _ width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State AQe-^°°~* /l .ems'" Date ° �'
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-5 -31060 (31)
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13 -5 -31060 (2) 13 -5 -31060 (3)
13 -5 -31060 (4)
13 -5 -31060 (5)
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-5 -31060 (31)
13 -5 -31060 (32)