OPHTE# o5 ) Harnett County Department of Public Health 21 2 2 5
PERMIT # tiA §~p Operation Permit
New Installation XI Septic Tank ❑ Repair)Q Nitrification Line ❑ Expansion
PROPERTY LOCATION: M sc `-\,oW E2 Vp
Name: (owner) C-\ 1- 6 uk -'O Eig-5, SUBDIVISION ~'A~a cvs r a-c LOT # J Q
System Installer: Sl'C--s tA c,, L- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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.
]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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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No V
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~ Other 2 ~i 4 w Septic Tank: t X (0 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditdtes of each ditch 1. O feet ditches feet ditches a4-30 inches
French Drain Reouired: feet
Authorized State Agent Date 1
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