OPNTE#16'SbG Harnett County Department of Public Health 24552
PERMIT #x1103 Operation Permit
New Installation Septic Tank Xi Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: --79:< 9bRn sz G(trt 6 C1eD
Name: (owner) L ry 9 A bit 4%L L SUBDIVISION LOT #
System Installer: �1 omr. / Catcy Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type:'rim o 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.
mn >ruan nu ucrn imuneu m wnrynance min appocame norm Lamina Moral ammRS, rules inr
1. 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 ❑ NAX
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other
maintenance and reporting.
all conditions of the Improvement Permit and Construction
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of- em: El Conventional � Other E"2. �Lcaw Septic Tank: t 00 0 gallons Pump Tank gallons
Subsurface o. of exact length width of depth oL
Drainage Field ditche 1 of each ditch 1 {- 0 feet ditches 3 feet ditches 3 0'�% inches
French Drain 'near feet
Authorized State Agent Q&De Date S/ tg
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