OPHTE# Harnett County Department of Public Health 23102
PERMIT # K770- Operation Permit
ZrNew Installation IJ Septic Tank dNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 4 1L SUBDIVISION a 1 LOT # (z Z
System Installer: Registration #
Basement with plumbing: ❑ Garage El Number of (edrooms
Type of Water Supply: ❑ Community L'J Public ❑ Well Distance from well feet
System Type: .lam 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.
❑us system nas oeen mstmiea in compuance w¢n appncaoie norm Larouna benerai Statutes, rules for Sewage treatment and Disposal, 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.
111. 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 ❑
Following are the specifications for the sewage disposaksystem on the above captioned property.
Type of system: El Convent [� Other r'—J-0 4 Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch 7S— feet ditches _
French Drain Required: �� 1;�&ear feet
H2OLine ❑ PWR Line
cc c) gallons Pump Tank: t Uc)® gallons
depth of
3 feet ditches 16 _ inches
Authorized State Agent 9—C—aA � Date 5
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