OPHTE#-14--53-"r7)S7 Harnett County Department of Public Health
21 F
PERMIT # Operation Permit
kNew Installation Septic TanNitrification Line EJ Repair 1:1 Expansion
` PROPERTY LOCATION:
i
Name: (owner) YvI -�OmCr-S lN4- SUBDIVISION i")LOT # 5
System Installer: 1j 4 S EP T� C.- Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Commani X Public ❑ Well Distance from well LO 0 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.
anis system nas ween mstauea in compuance with appocaove north Larotma jeneraf statutes, awes tor sewage treatment ana uisposai, ana an conatteons of the Improvement Permit and Lonstruction Authorization.
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NtKM11 LUNDIIIUNS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
t R 69 Jp" t2 r
s 1 33
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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
If yes, see attached sheet for additional operation ct
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other E'2 'w Septic Tank: I 0J<!) gallons Pump Tank: gallons
Subsurface 11 No. of exact length 4 width of depth of
Drainage Field 31i treses 5 of each ditch feet ditches feet ditches , inches
�\
French Drain Reauired_ Linear feet
Authorized State Agent ___ Date `� �%