OPHTE# O'::'l --5--,05N1 Harnett County Department of Public Health 2 0 5 4 4
PERMIT # ,515~0 Operation Permit
New Installation Septic Tank ❑ Repair~4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: Qs,
Name: (owner) MAccsye.Ro, ~~1-~~,.s SUBDIVISION LOT #
System Installer. 7'* 5 fl K•rY~ F MS Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ~t
Type of Water Supply: ❑ Community ]K Public ❑ Well Distance from well 100 feet
System Type: x 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.
uns sprem nas ueen mscauea in compuance wim appncame norm tarmma General Statutes, Rules for Sewage Treatment and
and all conditions of the
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Permit and Construction Authorization.
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1. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other EZ Vt. ew Septic Tank: f oo <Z5 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ffeach ditch feet ditches 3 feet ditches inches
French Drain Reauired: n \ Pt\\
Authorized State Agent Q-5 Date L+ I Q QM
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