OPHTE# 0>S-sow at~~-7 Harnett County Department of Public Health 21 3 7 9
PERMIT # Operation Permit
i:5-New Installation Cam-Septic Tank ❑ Repair [;Nitrification line ❑ Expansion
PROPERTY LOCATION: tJ c
Name: (owner) SUBDIVISION c,-
~ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 75-.Number of Bedrooms _ 3
Type of Water S ly: ❑ Community ublic ❑ Well Distance from well feet
System Type: fir. 0 --t' ~ - 2 .F 1 C~~ Types V and VI Systems expire in 5 years.
(In accordance with Table a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961. nC~
As required by Rule .1961. !1f`~ ~ S )r c
As required by Rule .1961. Other.
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IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other. Quryo. (a ~r~ ~bNC-q a10:L- G.. ~cG4 c,~ C)
Following are the specifications for the sewage disposal ~ntem on the above captioned property.
Type of system: ❑ Conventional Other ~Y Se
t.~~ L l ptic Tank: ~ _ gallons Pump Tank: '-1 gallons
Subsurface o. exact I ngth width of depth of
Drainage Field ditches each ditch feet ditches 3 feet ditches inches
French Drain Required: \ I ~nP PP
Authorized State Agent_ TL~ Date .1 Av
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