OPHTE#o5-~ I6 - Harnett County Department of Public Health 21230
PERMIT #Operation Permit
New Installation `K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: BAN '~-y
Name: (owner) Moss SAon,E SUBDIVISION Gre-P.Qs ~I,Ne~s LOT # Lf
System Installer: Ll:) - rr __1o4A'4so" Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I.oC~ 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.
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:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the s ecifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No of exact length
Drainage Field ditches of each ditch 2l`4 d feet
French Drain Reauired: ~ font
Septic Tank: I OOG gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches <)Lf inches
Authorized State Agent Date t 134 ►o
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