OP RHTE# 10 QL Harnett County Department of Public Health
PERMIT # a~a,61 Operation Permit 2 2 2 3 7
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: CoatLg-Sso^tC U2
Name: (owner) Eaa~a.aGS~sk.y orn ~Aor,ES SUBDIVISION 0-21y c)r., CALo55 LOT # 4q
System Installer: C -rNs Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms 3
Type of Water Supply: El Community 'Pl\ Public El Well Distance from well \00 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.
Ihls system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Dispo I, and all conditions of the Improvement Permit and Construction Authorization.
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DCDMIT MkInITIMIC.
1. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other , - - Q EZ dW Septic Tank: ♦b gallons Pump Tank: } QeO gallons
Subsurface o. of exact length _ width of depth of
Drainage Field ditches , of each ditch feet ditches feet ditches or). 2) inches
French Drain Reauired: ® Llr~feet
Authorized State Agent ~ 3~ V-Z--\5 Date ~'la k t) a
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