OP RHTE# \3-5=31t15Q Harnett County Department of Public Health 23760
PERMIT # Operation Permit
New Installation Nk Septic Tank A Ni rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: e)vflrraeJ
Name: (owner) G4LaCLGC SGueipoap P so SUBDIVISION LOT #
System Installer: T-► s ion-r2lij Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4 rt
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: _=1 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims sprem nos oven mstaneo in compnanu mm appnuore noun umnna uenerm ammms, ores mr nwage ueaement no unposm, ano an commons m me improvement rerot ano wnsuuaiun numonuanon.
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V
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11 ` (Z_ CP A V P
I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal sYste�m on the above captione°'�roperty.
Type of system: ❑
Conventional Other Ut'-A •,= =%
Septic Tank: tea gallons Pump Tank: gallons
Subsurface
Drainage Field
No of exact length
ditches of each ditch aU-0 feet
width of 2 depth of
ditches feet ditches inches
3
French Drain Required:_sear feet
Authorized State Aeent N\\� P_.111 Date
13-5-31�1��