OP RHTE# /O_~ mv-~ Harnett County Department of Public Health
PERMIT 1 Operation Permit 21 8 0 7
Z'lNew Installation E~r Septic Tank 2 ""Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L
Name: (owner) AL - .-f 0L<, :mvi- SUBDIVISION df- L0,- d LOT # 01
System Installer: 13 r, t C,,4,1,-r Registration #
Basement with plumbing: ❑ Garage 1141, umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ~r 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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:
❑ D-Box ❑
Pump ❑ Alarm ❑
H20Line it b t fc PWR Line
Following are the specifications for the sew
disposal system on the above captioned property.
Type of system: ❑ Conventional O
ther , P L,.> Septic Tank:
f OG'U
gallons Pump Tank: gallons
Subsurface No. of
exact length width of
depth of
Drainage Field ditches
of each ditch 6feet ditches
-3
feet ditches inches
French Drain Required:
linear feet
Authorized State Agent
L
Date
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