OPH T E # c� ®�-3a "<), Harnett County Department of Public Health 23057
PERMIT #��` 3 Operation Permit
New Installation 'K Septic Tank �< Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t—v U� X21
Name: (owner) SUBDIVISION LOT #
System Installer: NA P gy Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well S b feet
System Type: t c, 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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal ,sistem on the above captioned property.
Type of system: ❑ Conventional �K Other 1 '2— L-Q-r Septic Tank: L ti C> Qi gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage ditches P of each ditchaso feet ditches feet ditches f'$ °30 inches
French Drain Required: ' ar feet
Authorized State Agent NQ ,1' Date
13 - 5 3x3 cra,