OPHTE# CFL-5---Q1~°► I Harnett County Department of Public Health 21 0 7 7
PERMIT # Operation Permit
New Installation )9Z Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: AzpsNE .D
Name: (owner) 15rLt~F.~ Lv~~ CO Nx SUBDIVISION SU.~ ~..06 LOT # t Q,
System Installer: Tea mac: ow r Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 140 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.
[hiss stem 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 CONDITIONS-
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
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: ❑ Conventional X Other Qy%c z. L~ CxxNr,, eEa- Septic Tank: i000 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch yo feet ditches 3 feet ditches 10 inches
French Drain Reauired:~,----
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Authorized State Agent *-G- S Date ) 01 13
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