OPHTE# 1—:&-5..3,cO3 Harnett County Department of Public Health
PERMIT # �" 6 Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
' L T"ROPERTY LOCATION: o
Name: (owner) 0 � (5c-,��2 ', �1ISUBDIVISION �
LOT #
System Installer: C°N N -, ``)T5L, cap, ," Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 2wner2ust contact Health Department 6 months prior to expiration for permit renewal.
rtnrui wnuiuuns:
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 El No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the ewage disposal on the above captioned property.
Type of system: El Conventional Other h 2 i c Septic Tank: 4 (25 Ch 0 gallons Pump Tank: tC500 gallons
Subsurface No of exact length width of depth of
Drainage Field ditches of each ditch —3S feet ditches — feet ditches ^30 inches
French Drain Required:
Authorized State Agent v :�, S Date
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