OPHTE#-I lHarnett County Department of Public Health
PERMIT # ~~--r3s Operation Permit 2 2 2 2 5
New Installation ~R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M~,2s
Name: (owner) Ho i>, .Q ~u ct~G¢5 LLSI SUBDIVISION LOT #
System Installer: -7-a o hao r ° Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 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.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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 sewage disposal system on the abov capti ed property.
Type of system: ❑ Conventional X Other tcC 2 Septic Tank: t CIO ® gallons Pump Tank: gallons
Subsurface oNo, f exact length width of depth of
Drainage Field ditches ~ of each ditch 1 feet ditches feet ditches inches
French Drain Reauiredc- ~iaear feet
Authorized State pent ~ Date
Y1- 1J -;C•l4t -1 1(
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