OP RRRRHTE# cf,-s-N-3 Harnett County Department of Public Health 21111
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair`s' Nitrification Line ❑ Expansion
PROPERTY LOCATION: Ca~,~tuL G~~crca~Q.D
Name: (owner) p)Zz - SUBDIVISION ~ ~t ►uN Oa,~es LOT # 1
System Installer: Ce,,i:~ Ea. C5 s-,E6eLo,,,, Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms L)
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well %00 feet
System Type: tvmy--l 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 mstafled 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.
Ill. 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.
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Following are the speci
fications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional Other Q u,--p > o F2--'~7L-ow
Septic Tank: t boc-)
gallons Pump Tank: 100 Q gallons
Subsurface
f exact length
width of
depth of
Drainage Field
French Drain Required:
ditches of each ditch CO feet
_ Pa Pt
ditches 3
feet ditches 01, inches
Authorized State Agent "16 Date