OPHTE# /zi '4z-7 < Harnett County Department of Public Health 23270
PERMIT # v2 o�8 Operation Permit
1 New Installation 2"' Tank [?Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C) ,k /: 4 S <_ c%,-, Xci
Name: (owner) C ,-R -4 SUBDIVISION LOT # fQ
System Installer: Z& S re, // / :P.f Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Y
Type of Water Supply: ❑ Community P"'Public ❑ Well Distance from well feet
System Type: 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 nas oeen mstaneo in compuance wan appocame nortn larolma Ueneral xatutes, Rules for sewage Ireatment and
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rcnrni LUNUnivno:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
and all conditions of the Improvement Permit and construction Authorization.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Z
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the agove captioned property.
Type of system: ❑ Conventional Other _a-c -I(q �.rlt�.n� e.r— Septic Tank: f000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch %J_ feet ditches feet ditches NCO inches
French Drain Required: Linear feet
Authorized State Agent ` ,' ; Date ft - v — 1_/
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