OP RRRHTE# 01-5-11% 1Q L(L Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 21 3
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: SMLf2f~tae„ %44e50e,
Name: (owner) JoI~U ~'Ervsacv SUBDIVISION HCar1a~.,~ ~,aS LOT # '3.0
System Installer: 2 tc;<:j Ko I-L-rapt -0 Registration #
Basement with plumbing: ❑ Garage ) Number of Bedrooms _
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I Od 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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rcnrin tvnurtivns:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: Rt Pl (~C~ 'ilx. 1N P:A'Arc1 C)Nc-~- r\
V. Other: `[)15T( %%UNt 0 N ~w~cg au Vt\ MAW\F'oLi~ AL1 SyS Serer rJQEG~~~C.OC~tC w~+` dN IP10-cl -5
N ~~`~+1 flEQasxt t~.,7~
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above caption d prop
Type of system: El Conventional Other 0,, H~g Cain ~Q1-l^ Septic Tank: 145>no gallons Pump Tank: % 004 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Vo,¢.xouS feet ditches feet ditches inches
French Drain Required: Linear feet ;k)Ao TcrckL, ~~Z Authorized State Agent Date i
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