OP RHTE# 06 J_ l,rs8/- Harnett County Department of Public Health
PERMIT #023 3 r Operation Permit 21 8 3 9
dNew Installation 12"'Septic Tank E' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -
Name: (owner)., SUBDIVISION C- t-;I.; C_1 946r LOT # qD
System Installer: f~ : mot" Registration #
Basement with plumbing: ❑ Garage Gtr Number of Bedrooms ..tF'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: G- 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.
FL111111 WIND MV1,J.
1. 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 01"'
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 sewardisposal system on the above captioned property.
Type of system: ❑ Conventional Other L Zic/dW Septic Tank: Uc?U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -2 feet ditches feet ditches / inches
French Drain Required:
Linear feet
Authorized State Aten
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