OP RHTE#o`~-5-aag35j_ Harnett County Department of Public Health
PERMIT # a ~3 Operation Permit 21 5 81
New Installation ~K\Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: RDaFri
Name: (owner) ~t3Q~a Li i~NcE~Bz SUBDIVISION N ~Jz~cvrc LOT #
System Installer: C P\Q,o t=N EZ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 1-
Type of Water Supply: ❑ Community ❑ Public Well Distance from well i c o feet
System Type: rf 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.
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and all conditions of the Improvement Permit and Construction Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the ,wage disposal system on the above captioned property.
Type of system: ❑ Conventional Other G-2- Y711 Septic Tank: \ 5n gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch Sad feet ditches 3 feet ditches a`-1 inches
French Drain Reauired- _ ~ r fpm-
Authorized State Agent hS Date 8ICAI 10
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