OPHTE# 13 �T- 31 L'3 ? Harnett County Department of Public Health 23071
PERMIT # 17 515- Operation Permit
P'New Installation P Septic Tank itrification Line ❑ Repair ❑ Expansion
r PROPERTY LOCATION: -q
Name: (owner) T!1 f. 4 14 t7 / SUBDIVISION LOT #
System Installer: L.e2 �51ew �'_ a >+�y Registration #
Basement with plumbing: ❑ Garage ber of Bedrooms { _
Type of Water Suppl : ❑ Community R— Public ❑ W 11 Distance from well feet It—
System Type: =��` "� 5- 5 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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1. Performance:
11. 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 ❑ No P1
If yes, see attached sheet for additional operation conditions, maintenance and reporting
,Ell" D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal syste o t e ab ca do d property.
Type of system: 0 Conventional L�f Other (2 6 Septic Tank: JOW gallons Pump Tank: "� gallons
Subsurface No. of exact length width of n depth of ,
Drainage Field ditches of each ditch 1 feet ditches feet ditches (� C� inches
French Drain Required: Linear feet
Authorized State Agent 4_V' P Date % () / 0