OPNTE# I7-5-4a12aN Harnett County Department of Public Health 24881
PERMIT # Operation Permit
New Installation '1K Septic Tank Nitrification /Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PSG MIN GTpN N 1LyQ
Name: (owner)G`Ar-S Irkome^ SUBDIVISION Ge`56. es LOT # 30
System Installer: T�QOIG Q~L, w,, Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms Li
Type of Water Supply: ❑ Community '4 Public ❑ Well Distance from well feet
System Type: — --,ITE r,. 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.
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Lonstrumon Authdnnuon.
I. Performance:
System shall perform in accordance with Rule .1961.
II. 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 conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alorm
❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abyve captioned prope
Type of system: ElConventional
', Other C=�PmBErL `NQC. 36 sT—�0/
Septic Tank: s00
gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage field
ditchesal of each ditch 3o O feet
ditches 3
feet ditches 11 --4 inches
French Drain Required:
a Linear feet
Authorized State Agent `31� Date
0
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