OPFITE# le) -'5 - 2-gZ60 Harnett County Department of Public Health
PERMIT # 7(,v ~FF Operation Permit 21 7 0 7
New Installation Q Septic Tank 12 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:STZtLl)2 G/r~;5~z sLxe,t gr)
Name: (owner)m~~.aGn 2c SUBDIVISION, LOT # J_
System Installer., i3,; Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance opt. well feet
System Type: 43 4t) Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owne ust jkn ct Health Department 6 months prior to expiration for permit renewal.
inis system nas ueen instauea in compuance wan
norm laronna ueneral statutes, holes for sewage treatment and ulsposal, and an conditions of the Improvement Permit and lonstruction Authorization.
rtnrni l.unuiiiuNS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned proper.
Type of system: El Conve ewa
ntional Other ?5°J~ iVebo V Septic Tank: 10 O gallons Pump Tank: t 00 c> gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 feet ditches feet ditches ( inches
French Drain Required: Linear feet
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