OPHTE# O°1 5 11 I2_ Harnett County Department of Public Health 21 0 7 5
PERMIT # Operation Permit
New Installation 'X Septic Tank ❑ RepairX Nitrification line ❑ Expansion
PROPERTY LOCATION: t~,) C.Nwy
Name: (owner) ~rsor,ees S - Lpsv~% SUBDIVISION
LOT # A.
System Installer: Qyv ss ~a.~a ~tp-sH Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 7!,
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 0 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.
[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 Conshruction Authorization.
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PERMIT 17MBITtnNC-
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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:
Y. Other QN-'c ; Lt„ C*LC IR'7 (5\ V-~ ) L-1-l' I L\ vGs
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other F-LV;..Gw Septic Tank: X000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch a~-S feet ditches feet ditches 18'a~ inches
French Drain Required Linear feet
Authorized State Agent \Z'`' Date I0)i ~ O'A