OPHTE #—- ��~��� Harnett County Department of Public Health 23037
PERMIT # Operation Permit
New Installation 'j Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: Qbcs
Name: (owner) cu:> > gN SUBDIVISION Q) LOT #
System Installer: ®,V� +s `-� Gz.� Registration # TT
Basement with plumbing: ❑ GarageX Number of Bedrooms Li
Type of Water Supply: ❑ Commum `K Public ❑ Well Distance from well 1® ® feet
System Type: b 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.
finis system nas peen mstanea in
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1 1lG V - t- 1
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
M, ,
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1.ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tioned roperty.
Type of system: El Conventional Other Q y M 1 O L.W-r Septic Tank: ti 0 4 O gallons Pump Tank: 4t) Q() gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch q D feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date t c3
13 -5 3t�3`�