OPHTE# I_I —5 `+aW�q Harnett County Department of Public Health 25065
PERMIT # 3�/ 0 eration Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: USL l
Name: (owner) P)Lo2 SUBDIVISION LOT # C
System Installer. '1 Gu Is e r- Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1110. 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.
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I. Performance: System shall perform in accordance with Rule .1961.
H. 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 ElAlarm
❑
H2O1-ine ❑ PWR Line
Following are the specifications for
the sewage disposal gstem onabove captioned
property.
Type of system: ❑ Conventional
)S<Other f-- 1_6w
Septic Tank: 1 eQS C�
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field'hes
X of each ditch 1s0
feet ditches 3
feet ditches St�'��S inches
French Drain Requir
Limar feet
Authorized State Agent 2 Date
yrs_
y
�y