OPNTE# k5— 53G66`? Harnett County Department of Public Health 23852
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:
Name: (owner) ��s �Fs uRi �OSS�— SUBDIVISION — LOT #
System Installer: TeZCL) T°1 ne I. -E5 Registration #
Basement with plumbing: ❑ Garage li;t Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well lt! O 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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Rums mr sewage neatment ana uiumsat, ana an mmmnions m me
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NooX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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❑
D -Box
❑ Pump ❑
Alarm ❑ H2O1-ine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above caption property.
Type of system:
El
I Other �.>-sAM�,C1L LQ�
Septic Tank: ec�o0 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
1 of each ditch feet
ditches feet
ditches JR_ inches
French Drain Required.Linear feet
Date V
Authorized State Agen� !>
15-5-3�6c4