OPHTE# O°1"SZ~ Harnett County Department of Public Health 2 0 81 5
PERMIT # -q Operation Permit
X New Installation 'K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: V-D
Name: (owner) SUBDIVISION \,taL-,4 Gciw ~ LOT # 3f-
System Installer: 3 Ny r~c--i_ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well u00 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 Construction Authorization.
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PERMIT rnkinITIAMC
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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: 5ys-1 E:-- L-a I~N Q"" "I0A'Fci. k Q(ywF.r? LwL S~~LZ`5~ ~iEC~cC~ otr t' a~o°1
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E`Z Vt-ow Septic Tank: 10QQ gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of c~ch ditch 3~ b feet ditches -3 feet ditches I inches
French Drain Reauired: n\
Authorized State Agent \ -.E 5 Date 11 1 3)e`'
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