OPHTE# I-- 5-14 47.6 Harnett County Department of Public Health 24763
PERMIT # 2 6Sa Operation Permit
New Installation �4R Septic Tank �K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Oso USL N11
Name: (owner) Ga2y�gA� a kon.Es SUBDIVISION �HN.mwti 1arv�o2 Iia LOT # 7
System Installer: Eoo.E Gprt'"A2 Registration #
Basement with plumbing: El Garage '' Number of Bedrooms
Type of Water Supply: ❑ Commssnity V Public ❑ Well Distance from well feet
System Type: 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.
uenerai muum, nmes Tor sewage measment am msposat, am an mmiouns m me improvement reran¢ ano s.onsmocnon wmonuaon.
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I. Performance:
System shall perform in accordance with Rule .1961.
If. 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.
❑
D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the move captioned prope
Type of system: ❑
Conventional Oth, -
Septic Tank sooy
gallons Pump Tank gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field _
ditches of each ditch ay0 feet
ditches 3
feet ditches (B ^30 inches
French Drain Required: l near feet
Authorized State Agent Date SS aS 1Z
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