OP RHTE# Ib— a -5' Q, Harnett County Department of Public Health 23828
PERMIT #`oi�j$3�ri Operation Permit
New Installation �9 Septic Tank')< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1a -*q jg:7 %,r4
Name: (owner) SovT„Sco,-4 SUBDIVISION—1LOT # tea.
System Installer: Jo v ,, ,4 kra. 6 %T Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t 00 feet
System Type: a Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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PERMIT
I. Performance: System shall perform in accordance with Rule .1961.
11. 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. No Novse, 0.. '1 O"—Tjtw.C. Oe Tevs:atty'slo„s
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other iz2 Fi.. w Septic Tank Io00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field a of each ditch O feet ditches feet ditches inches
French Drain Required: Linear feet SLU-0v pak'q A%. (19>"
Authorized State Agent N\ Date
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