OPHTE# C5-S-`a" a°R Harnett County Department of Public Health 2 0 7 8 0
PERMIT # asl S~ Operation Permit
New Installation X Septic Tank El RepairX Nitrification Line 0 Expansion
PROPERTY LOCATION: \141tLL- L-vc.AS (2-p
Name: (owner) P Nm ~E~EtryQthE SUBDIVISION Cono~sNP. C~a~s LOT # 11
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Soa feet
System Type: q~ \0 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.
ims system naz oxen mstanca In compliance wnn appucame North larolina beneral Statutes, Rules for kwne Treatment and Disposal and all conditions of the
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Permit and Construction Authorization.
rtnrlll WFIL)HIINY
1. Performance:
11. Monitoring:
111. 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 ❑ Na)K,
If yes, see attached sheet for additional operati n conditions, maintenance and reporting.
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 hes 1 of each ditch a`iD feet
French Drain Required: -,-J4near feet
Septic Tank: 10C)C> gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches _4~) inches
Authorized State Agent ` l," 1;~5 Date 6I s