OPHTE# 01- -a~gq I Harnett County Department of Public Health 2 4 8 Q 9
PERMIT # Operation Permit
New Installation )~J, Septic Tank ❑ Repair)K Nitrification Line ❑ Expansion
PROPERTY LOCATION: Hwy 40 1
Name: (owner) 1- pmx-4tpoy ~or~ES LL C. SUBDIVISION LOT #
System Installer: R~►-s,-LQ C-a-lz 82- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tt7o feet
System Type:a 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.
[his 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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PERMIT rnunITIMIC•
I. 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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional 'X Other Q~ u 4 C~g,n gErt Septic Tank: I C7b co gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 6 0 feet ditches 2_ feet ditches L- inches
French Drain Reauired: . I i,wat foot
Authorized State Agent ~~~~(Z~- ks Date
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