OPHTE# o°► Harnett County Department of Public Health 2 0 81 8
PERMIT # Operation Permit
New Installation -lam, Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~,~~,y L.~/MM\N CS SUBDIVISION `*Joofl~x~nE LOT # 1°1a
System Installer: d ~s STa~-~- Registration #
Basement with plumbing: ❑ Garage Ti~ Number of Bedrooms
Type of Water Supply: ❑ Community tR Public ❑ Well Distance from well 100 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.
Ibis 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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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NOIX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. 6y5sC=rn C-A(--C-VLO 6`1 M . U-2- QQ VF
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ-
Subsurface No. o exact length
Drainage Field ditches a \ of each ditch $ feet
French Drain Required: nrt
Septic Tank: t a(5 C) gallons Pump Tank: gallons
width of depth of
ditches feet ditches a -30 inches
Authorized State Agent Date 1c~-A o~
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