OPHTE# D -,Q3 c~13o~( Harnett County Department of Public Health 2 0 5 8 5
PERMIT
Operation Permit
( New Installation lSeptic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: /COQ r,?7
Name: (owner) ~M l ~ y~~ ~s SUBDIVISION LtRc }c LOT #
System Installer. =-7-100 Ljc Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -y
Type of Water S ly: ❑ Community Public ❑ Well Distance from well -10 feet
System Type: Mrvo -1, 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.
rcnrui wnviuvn}:
1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Operation:
Other.
Subsurface system operator required? Yes ❑ No_L)~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
following are the specifications for the sewage disposal {1~tem on the above captioned property.
Type of system: ❑ Conventional ,Other Lk Septic Tank: 030 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 30 O feet ditches _3 feet ditches _ inches
French Drain Required: Linear feet
Authorized State Agen
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