OP RHTE# ,s'S 3s C C/t Harnett County Department of Public Health 23461
PERMIT # oZ a.b2 Operation Permit
2" New Installation IR"'ieptic Tank H�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: A
Name: (owner) J a,,er -fezj, 1 SUBDIVISION LOT #
System Installer: C:i4- rJ' Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms q
Type of Water Supply: ❑ Community ❑ Public ff"'Well Distance from well feet
System Type: 1 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 nas peen enstauea in
A, bi-eq,
PFRMIT CONDITION(•
wim appocame norm taroima venerai mantes, nines for sewage ireatmem ana visposai, ana an conamons or me improvement rerm¢ ana Lonstrucaon Humonzatfon.
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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 ler
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the seewwaf disposal system oo the above captioned property.
Type of system: Eltiona
Convenl Lid" Other Z �1o:Ij
Subsurface No. of exact length
Drainage Field ditches % of each ditch feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: / 00 ® gallons Pump Tank: gallons
width of depth of
ditches t3 feet ditches A inches
French Drain Required: Linear feet
Authorized State Agen —,y4- ��-=-E my- Date �2°e,s`