OPHTE# 1 0 PERMIT #
Name: (owner) t_t~sL~
System Installer:
Basement with plumbing: ❑ Garage Number of Bedrooms
Harnett County Department of Public Health 2 1 5 0 0
Operation Permit
New Installation 'lik Septic Tank ❑ Repai Nitrification Line F-1 Expansion
PROPERTY LOCATION: MP,cz'y,* 'V--Q
C-1-1- 0 `"`C-5 SUBDIVISION S~~G~d2,n LOT #
Registration #
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Sid feet
System Type: -u~-~ 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.
V. Other.
Following are the specifications for the sewage disposal system on~I~e a ove ca ed properly.
Type of system: ❑ Conventional ~ Other Py P l F `C oW
Subsurface No. of exact length
Drainage Field ditches _ of each ditch (20 feet
french Drain Required:
Septic Tank: l O C) 6 gallons Pump Tank: C gallons
width of depth of
ditches -3 feet ditches
D~o '"4 inches
Authorized State Agent Date
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 requiredi yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
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