OPHTE# o°►-~~~~~ Harnett County Department of Public Health 2 p 5 4 9
PERMIT # a5 Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification line ❑ Expansion
_ PROPERTY LOCATION: s 3a.5 Fey V-
Name: (owner) Jo"*, ~i. K. SUBDIVISION LOT #
System Installer: vvE (Zp,~ Registration #
Basement with pltmbitt ~ Garage ❑ Number of Bedrooms ._-3
Type of Water Supply: ❑ Community ❑ Public Well Distance from well t CDC feet
System Type: a-)2 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.
m> ~pmm nee peen msuneu in compuance win appuCable North tarofma General Statutes Rules for Sewage Treatment and Disposal and-*11.eonditions of the Improvement Permit and Construction Authorization
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PERMIT rnldnITfnld6
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 ❑ NoA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are th specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches ditch d feet
French Drain Required:- a~ \ \
Septic Tank: k o d0 gallons Pump Tank: -
width of depth of
ditches I d feet ditches
gallons
inches
Authorized State Agent Date -t 1 1
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