OPHTE# IC)-S-a ge Harnett County Department of Public Health
PERMIT # r;1. 1 oy Operation Permit 21 6 2 6
New Installation -N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) v r~2>~,~, fl ~o ME ~ SUBDIVISION ~1 ~ cL'✓ ~p„~ c~-1 LOT # yb
System Installer: t ~,o ~cu>w c.r Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well too feet
System Type: -11 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.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
7L~ ~o
❑ D-Box 1 Pump 1~ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional Other Pv -~S G E~1 (@ ~k > Septic Tank: ' d 4 G gallons Pump Tank: Q Q (j gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch of each ditch 9,00 feet ditches feet ditches inches
French Drain Reauired, \ - Z1- I-
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