OPHTE# 0 T 5,) 0 YY ,-t Harnett County Department of Public Health 19886
PERMIT # a, Operation Permit
-J4 New Installation -Z. Septic Tank ❑ Repair42 Nitrification Line ❑ Expansion
PROPERTY LOUTION: L < n., c ( ) A cl f a S
Name: (owner) U t 14, SUBDIVISION CAA-\,L \AA\J LOT # L _
System Installer. t r-~ NrV2 < _ Registration # 1 to
Basement with plumbing: 11 Garage 70 Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well iStan a from well feet
System Type: -7 rL c C~., qS Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
TMs system has been uncalled in compliance with appfidk north Carohna General Statutes, Rules for Sewage Treaawt and Disposal, and A condition of the knKmemw Permit W CommKw kudioizbon
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1. Performance:
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes. see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other lt-t tV, Size of tank: Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 1
Drainage field ditches _ of each ditch T feet ditches feet ditches ` inches
French Drain Required: linear feet
Authorized State Agent Date l7 ~ - Q K
S