OPHTE#O'~ Harnett County Department of Public Health 21 0 7 3
PERMIT # Operation Permit
New Installation '~K Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LO(ATION: Lf,,L)E,L gL .
Name: (owner) ~AV~~t Es5 1 _ ~.N9 Q Ev rPMEr3~ SUBDIVISION be~w LOT # 1Vq
System Installer C.. CPr e-"- Registration #
Basement with plumbing. ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community 'Ik Public ❑ Well Distance from well 1OO feet
System Type: D1Y b 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.
this 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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1. 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. -N%3tS ~ LuES cmec'O"o%y v'C 0y"R taLp"". , Uttt_\n ~a~.16 S,t,~-Sa SE Ca+6G"~fD
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~i-, Other Pv•~w`~ 1IQ-E Cm, ,s Septic Tank: X000 gallons Pump Tank: )_000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ~itchrs { ` of each ditch 0 feet ditches 3 feet ditches Sg -a~ inches
French Drain Required: a . linear feet
Authorized State Agent_ 9~15 Date
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