OPNTE# ? — �' — yOSL( Harnett County Department of Public Health 24633
PERMIT # Z� Ia) ,Operation Permi
New Installation eptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_4 t. l a+wa.aa a-, 02't'-&4- c -et
Name: (owner) 'i CA& eSUBDIVISION LOT #
System Installer. njNA:.e, 5Jry A Registration #
Basement with plumbing: ❑ Garage ❑ other of Bedrooms w A (O&LID AA;
Type of Water Supply: ❑ Community Id Public ❑ Wel Distance from well feet
System Type: Z5` Types Y and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
o sra¢m nm uv empname nine arpmame nmm umn.. Yedeea...wa, WRS nor Jewage Ireameni no u spofal, and all cora tions of one
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PERMIT
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
111. 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.
remit and
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ' osal system on the above' erty.
Type of system: ❑ Conventional ca Other 2 �G`p Septic Tank: 16>0U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch 30 feet ditches _ feet ditches Zi/ inches
French Drain Required: Linear feet
[Authorized State Agent Date V 41 10/z 01-;�`
'000
6s