OP - Filed with RepairsHTE# /4/-s- J/75_7 Harnett County Department of Public Health 23429
PERMIT # a6 f t ( Operation Permit
❑ New Installation Cry'—Septic Tank 2'—Nitrification Line 2' Repair ❑ Expansion
PROPERTY LOCATION: 6-6 9 5" uS' Y'Z.
Name: (owner) 1Z vr, SUBDIVISION LOT #
System Installer: SIV; r14":.mac/ffW�_ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community [i?�Public ❑ Well Distance from well feet
System Type: ,[7��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.
anis system nas peen mstanea in compuance wim appucaoie norm Lamina uenerai statutes, KUM for sewage ireatmem ana visposai, ana an conn¢ions or the improvement rermn ano t.onstrucaon Autnonzation.
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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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Required:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewMT disposal system on theab9ve captioned property.
91 Other �', c e a1 c*Septic Tank: /Q2O gallons Pump Tank: gallons
exact length width of depth of
of each ditch 9 f 0 feet ditches feet ditches /0-40 inches
Linear feet
Authorized State Agent/�<.t �� �% Date l.I. / 2'I .Zciy
/ q-5-'-- :� Y 7-5-�