OP RHTE #J L- Harnett County Department of Public Health 23412
PERMIT # ��O13 Operation Permit
l New Installation ❑ Septic Tank 4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1`16 NG��t�iss
Name: (owner) %A o t.--/ Q s� �vE2p.NcC- SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ — Bed+ee+s
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well feet
System Type: - 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 LONDITIONS:
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: 00 K111'VC1\Nrc.N N.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the aboya capti°�ed property.
Type of system: ❑ Conventional .� Other �*�Q+n\AC�2_ `Q� �J Septic Tank: � %�� }N gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ' ditch i4 of each ditch Q- feet ditches feet ditches inches
French Drain Reauired: _ Linear feet
Authorized State Agent 2r- H� Date 1 __1.0 I 1
11�- 5 -- `3L15Q-