OP RHTE# 10-s a5aa~tZ Harnett County Department of Public Health
PERMIT # 91(- Operation Permit 21 8 7 5
New Installation '1~4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Grz~,~ am
Name: (owner) d~ e,o "vJ 1 L--. o ~j SUBDIVISION LOT #
System Installer: `-Sc_ cozy nt,2cL-s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 Od feet
System Type: _7 -M, 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.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other \'az- C\\\e5 Septic Tank: 1 Oad gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch of each ditch 100 feet ditches feet ditches 1V®~ inches
French Drain Required: inealrfket
Authorized State A¢ent~" Date
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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