OP RHTE#CYq'5-ti�l`13fL Harnett County Department of Public Health 25075
PERMIT # Operation Permit
New Installation 'W Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 4asr-.r i.A G�%
Name: (owner) lN,ornvs.) C -v t.a CXXC-'q Cz SUBDIVISION #
System Installer. r c w %NczC Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: s h �4 >Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
of the Inproeement Permit and Construmon Authorization.
$N M'
into
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
H2OLine ❑
PWR Line
Septic Tank: 1000 gallons Pump Tank: 00d gallons
width of depth of
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date S