OPHTE# T 6—Sl"V I'i
PERMIT # VNC)-�-
Name: (owner) S a ralloaul
System Installer: o-a� N L.,
Basement with plumbing: ❑ Gara
Type of Water Supply: ❑ Community
System Type:
(In accordance with Table V a)
Harnett County Department of Public Health 24283
Operation Permit
New Installation 'X Se tic Tank X Nitrification Line El Repair El Expansion
PROPERTY LOCATION: �(-t'
nev+p_ S6wiQe2S SUBDIVISION11omQa n%Nad LOT # Z).
Registration #
Number of Bedrooms 1
Public ❑ Well Distance from well feet
t5 Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
inn system nas peen inssmea in rompnance wit, appucame moan carouna oenerm smmes, nues for sewage rteaanem no
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
fl
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W sOGEoN 4,1�+�
ana an conamons or me improvement remit ante comrmamn numonzanom
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation c editions, maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional Other
� -2- �7L &,a Septic Tank: l4t)0 6
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length width of 3
of each ditch q C5 feet ditches
depth of
feet ditches kO"3Q, inches
French Drain Required Linea et
Authorized State Agent (?Lw5 Date l0�tb