OPHTE# 1LAr5 -7G_ Harnett County Department of Public Health 23405
PERMIT # � ®6 Operation Permit
kEl Installation � Septic Tan Nitrification Line Repair ❑Expansion
PROPERTY LO(ATION: iGZL-� 1L� —fl62
Name: (owner) Cti c.�.E.C—_ Lt—C SUBDIVISION LOT # }QC)
System Installer: QD ®,G ea Registration #
Basement with plumbing: ❑ Garage)< Number of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well 1W 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.
ims system has peen instaued in compliance with appucame north Larmma uenerat xatutes, rimes for sewage treatment and
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and an conditions of the
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II.' Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noy
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
rermt and Lonstructton Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the a ove ca oned property.
Type of system: El Conventional ;, Other �. 8 2 +N Septic Tank: 1(780 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ttct l of each ditch aT d feet ditches 3_ feet ditches X inches
French Drain Reauire& _ feet
Authorized State Agent Date
1 -I- 5- 33'ns-