OP RHTE#~t-S-aU5Q 2. Harnett County Department of Public Health 21 0 8 5
PERMIT # a5 S 1~b Operation Permit
A New Installation ~M Septic Tank 0 Repair Nitrification Line El Expansion
PROPERTY LOCATION: OLO tea,}
Name: (owner) "„En- 4 M PQ:-J l~ a2c ~ "I SUBDIVISION Ross M ~R~ S~z.AE LOT #
System Installer. 5'-, L- u% bens Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: cr, 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.
Inns 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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V III III \.V I\YI I IV I\J.
1. Performance: System shall perform in accordance with Rule .1961.
H. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
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 )I OtherT-.2-'F~,4 Septic Tank: 10 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche~ of each ditch 50 feet ditches 3 feet ditches A4 -30 inches
French Drain Reauired: I inoNrJnat
Authorized State Agent_ 2\~ V-L'~45 Date Id
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