OP RHTE# 13 -x-302 Harnett County Department of Public Health 23140
PERMIT # Operation Permit
New Installation �K Septic Tank' . Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: �.Iy.1��r'1ot,1 LN
Name: (owner) L&N oN Ai f- SUBDIVISION LOT #
System Installer: fl G Ge,"c ,cZ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well feet
System Type: c. 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.
tnis system nas oeen mstanea in compuance w¢n appucame nortn carmma aenerar xamtes, naves ror sewage ireatment ana uisposai, ana an commons or the improvement rermit ana lonstructmn Authorization.
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PERMIT CONDITIONS:
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 sewage disposal system on the above capti d property.
Type of system: ❑ Conventional Other �a�C� ?. Septic Tank: 1C�0 gallons Pump Tank: gallons
Subsurface -Ng. of exact length width of depth of
Drainage Field ditches i. of each ditch 30 O feet ditches feet ditches 1'9 3 inches
French Drain Required,„ «-�,, ..Linear feet
Authorized State ARent�. �'a;` NHS Date
1i - 6-- ,� acc() .