OP RHTE# 08-5---21Z Z Harnett County Department of Public Health
PERMIT # c~ Operation Permit 21 5 31
E New Installation ErSeptic Tank E'I trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ a:77-F
Name: (owner) A.,, SUBDIVISION -7`° ,sr=- LOT # /
System Installer: " few Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community 1 Public ❑ Well Distance from well feet
System Type: .Lf` 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 nas peen mstaneo in compnance w1m appllcalne Norm 1araima beneral statutes, Rules for sewage treatment and
and all conditions of the Improvement Permit and Construction Authorization.
rcal9n Lununlunx
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sews disposal system on a a°ve ca~HOned property.
Type of system: El Conventional 0Othe. t cC - V Cj1 j*-b<-- Septic Tank: /Coo
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditch feet ditches
French Drain Required: linear feet
Authorized State Agewtt
Date
H20Line ❑ PWR Line
gallons Pump Tank gallons
depth of
feet ditches inches
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