OPHTE# iZ-S- uZo23 Harnett County Department of Public Health 25123
PERMIT# 29 Operation Permit
C3'�New Installation [?" eptic Tank aNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Vd /
Name: (owner) BDIVISION 6 LOT #
System Installer. /j% Registration #
Basement with plumbing: ❑ Garage Nmnber of Bedrooms 3
Type of Water Supply: ❑ Communityf��Public 11 Well Distance from well feet
System Type: QTS)yNle, ZZ� C� -LY�S� 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.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system onthe abovy/7 do ed property.
Type of system: El Conventional ❑ether Z�z &C Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch too feet ditches feet ditches_ inches
French Drain Required:
Linear feet
Authorized State Agen �
"--"� 2
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Date
17-5-42893 (1) 17-5-42893 (2) 17-5-42893 (3) 17-542893 (4) 17-5-42893 (5)
17-5-42893 (6) 17-5-42893 (7) 17-5-42893 (8) 17-5-02893 (9) 17-5-42893 (10)
17-542893 (11) 17-542893 (12) 17-5-42893 (13) 17-5-42893 (14) 17-542893 (15)
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