opHTE# Ifo' S-3-791 Harnett County Department of Public Health 23968
PERMIT # a 4 i 5L� Operation Permit
New Installation �K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Docs Qs�
Name: (owner) SUBDIVISION Q!Ic Yy—moara LOT # 0
System Installer: -t ,c- �. Registration #
Basement with plumbing: El Garage Number of Bedrooms
Lj
Type of Water Supply: ❑ Community 'X1 Public ❑ Well Distance from well tb n feet
System Type: w 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.
inn sysrem na oeen insuneo in mmpnance wim appnume noun urmma uenem xamms, nines Tor xwage imannem no
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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ano an mna eons or one
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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 ❑ Noo
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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❑ D -Boz ❑ Pump ❑ Alarm Cl
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E'6—FL-O+sJ Septic Tank t bOG
Subsurface No. of exact length width of
Drainage Field ditches L} of each ditch b S feet ditches
rermu ano consnumon Rumonzanon.
H2OLae ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 1 Q inches
French Drain Required: Linear feet
Authorized State Agent Date S X71 ICS