OPHTE# /.3 Harnett County Department of Public Health 23090
PERMIT # a7 'L' Operation Permit
IE New Installation fT Septic Tank el"-Nitrification Line ❑ Repair ❑ Expansion
/� PROPERTY LOCATIO� i.��`t�'4
Name: (owner) V. �VAlt 1. -'L /`/ v '�- V^ SUBDIVISION LOT # 5'7
System Installer: 7- diarz�`'��.,A Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 3jAlic ❑ Well Distance from well feet
System Type: Ll-L G° 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.
ims system has been mstaheo in compliance with applicable North larolma General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and construction Authorization.
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewwaa disposal system o the above captioned property.
Type of system: ❑ Conventional (d Other �Z-F71,, Septic Tank: dLr" gallons Pump Tank: gallons
Subsurface No. of ! exact length width of depth of
Drainage Field ditches L( of each ditch 80 feet ditches -3 feet ditches -Z6 `� inches
French Drain Required: Linear feet
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Authorized State Agent f� Date o2. / 020/
/5 - S- 7 2 -'),z-6