OP RHTE #, I -5- M Q Harnett County Department of Public Health
PERMIT # Operation Permit 22773
New Installation X Septic Tank�X ANitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M NgA
Name: (owner) Cs ;'tN C-0 c Asp a c;'i �oQ SUBDIVISION t a 3 C'e.tj ),P,cE LOT # a.6
System Installer: `"TEE ,a rj Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well _10 Q 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.
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I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑
Following are the specifications for the sewage disposal system on the abovercaption d property.
Type of system: El Conventional Other �.h��4 \s tai `'� Septic Tank: tto0 gallons Pump Tank:
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch i a.0 feet ditches - feet ditches]
French Drain Reauired:..n \ h feet
Authorized State Agent Date i
PWR Line
gallons
inches
W- S. ZZIIW'V-