OP RHTE# k U-R Harnett County Department of Public Health
PERMIT # ~6130 Operation Permit 21 6 3 3
New Installation X Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: govt o 2
Name: (owner) W~av~ fl~~bLO?MEscf SUBDIVISION 5u MK. LOT #
System Installer: M ~c S M QS o f Registration #
Basement with plumbing: ❑ Garage '~R Number of Bedrooms a
Type of Water Supply: ❑ Community '1~4 Public ❑ Well Distance from well t O O feet
System Type: a 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.
mo system nas peen mstanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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PFRMIT rn6/nlTlnlt4
1ST
Permit and Construction Authorization.
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other tCL C~ p5 Septic Tank: ~ b e gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ► 50 feet ditches 3 feet ditches ay -3 4 inches
French Drain Required: I,n - fnae
and all conditions of the
Authorized State Agent Date c'1~ 3 I I 1 d
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