OPHTE# 0A-5-4a Harnett County Department of Public Health 21119
PERMIT # 26591 Operation Permit
New Installation 'X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: t-E Mv~l, ~L
Name: (owner) "-,,NA Co~s~ c>vC.'Co(t~s ,N G SUBDIVISION Vo(LF~ Oa~.s LOT # t3
System Installer: Q>-, :5, 5ccz.c ~c~~N9 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3 lig, Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~0 C-) feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
tms 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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PFAMIT 0)NDITIM-
I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ riq- w Septic Tank: 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch L~8 feet ditches 3 feet ditches a4-3i0 inches
French Drain Reauired: v inailJ-f
Authorized State Agent 0-r;~v- 5 Date IA'6
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