OPHTE# 1-6 —5-3 ``�e� � Harnett County Department of Public Health 23052
PERMIT # �i�� 1 Operation Permit
' New Installation Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) H vc,in uCLLGS e> u i t_4eQ.> SUBDIVISION — LOT # 2-4
System Installer: 5 '5—s 7-,\ 'L-9� �49 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well le)o feet
System Type: cw 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.
finis system nas neen mstauea in compliance wim appocanie nortn Larouna General xatutes, rules for )ewage treatment and
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and all conditions of the
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the specifications for the sewage disposal system o he above captioned property.
Type of system: ❑ Conventional X° Other -Z-
Subsurface No. of exact length
Drainage Field ditches of each ditch 14® feet
French Drain Required:
Alarm ❑
Permit and Construction Authorization.
M
112O1-ine ❑
PWR Line
Septic Tank: 1 O Q G gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches �)'l ° I% inches
Authorized State Agent ~� ��`� �'�� �5 Date
13 - 5-'3 1'.6 -.q