OPHTE# t') 6 Harnett County Department of Public Health 25068
PERMIT # 9°1Q�5 Operation Permit
New Installation "R Septic Tank �5( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Got.,Fpe, Qj
Name: (owner) P%u" L --/c,-4 SUBDIVISION pa ar Lye. LOT # 3
System Installer. I—oaru-?,—j S?ipmjP$ Registration #
Basement with plumbing: ❑ Garage '5< Number of Bedrooms 3
Type of Water Supply: ❑ community Public ❑ Well Distance from well Feet
System Type: _ ��e 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.
..'M 22wueu 411 wmpnance wim appunme Ronh Carolina General Stumm. Ruks for Sewage Treatment and Disposal and all conditions of the Improvement Permit and
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hour
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I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D•Box ❑ Pump ❑ Alarm Cl
Following are the specifications for the sewage disposal �syysstem on the above captioned property.
Type of system:
El Other L F"o-v Septic Tank S 6 O
Subsurface Na. of exact length width of
Drainage Field ditches,
of each ditch 3� feet ditches
French Drain Requite Linear feet
Authorized State Agent_
Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches1-9 -e)b inches