OPH T E # I Com` s3�� ► Harnett County Department of Public Health 24559
PERMIT # a�CslZ Operation Permit
New Installation Se tic Tank )K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 9>•,IsznEF JattNsau
Name: (owner) G�`/ 5�� a4 O(1^mAt4 SUBDIVISION LOT # 1
System Installer: Gr1r— 'er -ao KM Registration #
Basement with plumbing: ❑ Garage�K Number of Bedrooms 31
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =a 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.
Imo system has been Installed in (compliance onto appoable North Carolina General Statutes,_ Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and contraction Authorization
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51-t�Z,�P 30NNSOsv QP
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I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 n
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s tem °� the above captioned property.
Type of system: El Conventional X Other %f. L \ 1-.O'�,y Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ---ditchs 4 of each ditch 15 feet ditches 3 feet ditches inches
French Drain RequirecL Linear feet
Authorized State AeentDate
16- Sa'3`1-3 e -J