OP RNTE# i6'5-SC1IYQ. Harnett County Department of Public Health 24286
PERMIT # Operation Permit
New Installation � Septic Tank:j Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 416 `4 % a.G
Name: (owner) -%cajPCb9 SUBDIVISION LOT #
System Installer. GC* \4 Registration #
Basement with plumbing: ❑ Garage -< Number of Bedrooms
Type of Water Supply: ❑ Community >K� Public ❑ Well Distance from well feet
System Type: —=I 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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Mill tunmiwns:
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 ❑ Ny K
IV. Operation:
V. Other.
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If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system �oP the above captioned property.
Type of system:
Conventional
X Other 5--Z,Vri_w Septic Tank: t 60 tY
gallons Pump Tank gallons
Subsurface�t
of
exact length width of
depth of
Drainage field
ditches
�- of each ditch s 0 feet ditches 3
feet ditches 1r inches
French Drain Required.
J.4ear feet
Authorized State Agent A&.r Date to 6
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