OPHTE# - s-yya Harnett County Department of Public Health 24719
PERMIT # ZOperation Permit
[?-few Installation D'Septic Tank 2 --Nitrification Line ❑ Repair ❑ Expansion
sb ke G rt e" pAu�z -sqe',"k PROPERTY LOCATION: 8Gy 6tr,.._t A. 21; st ILA - SL ;;kwM
Name: (owner) L. ,-N plc is n x� sr . SUBDIVISION LOT #
System Installer. C f s 5 4 r • g;.iKkC'6.N Registration #
Basement with plumbing: ❑ Garage E❑ "r of Bedrooms _
Type of Water Supply: ❑ Community lui' Public Cell Distance from well / feet
System Type: a 5 2 1 5 s � Types V and VI Systems expire in S years.
(In accordance with Table V a) y Owner must contact Health Department 6 months prior to expiration for permit renewal.
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I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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and all conditions of the Improvement Permit and construction Authorization.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
f�her Cg- </o
Septic Tank
x GSC- gallons Pump Tank:gallons
Subsurface No. of
exact length
3
width of
depth of
Drainage Field ditches
of each ditch -/CO feet
ditches
feet ditches 26—/S inches
French Drain Required:
Linear feet
Authorized State Agent Date 11 ( ca 112 pr i