OP RHTE#d, Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 6 4
'IR New Installation 'K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L- -L 9L K. 9--o
Name: (owner) ~A0-"eu. Eo0"- SUBDIVISION GAtLOT # 3"
System Installer: 05-S ~~rc~.cc ,~Nfl Registration #
Basement with plumbing: ❑ Garage `S~ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 00 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.
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z -9 L-6 \r-(
Subsurface No. of exact length
Drainage Field ditches , of each ditch 3 d (D feet
French Drain Required - Lineanfeet
Alarm ❑
Septic Tank: L6 d
width of
ditches 3
Authorized State Agent Qc-'\~5 Date -1
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
A
y
14
C~--I -5--1
Y`T
x
d4 $
04,
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