OP RRHTE# 0`7..5- 1131a fZK Harnett County Department of Public Health 19933
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepalrX Nitrification Line ❑ Expansion
PROPERTY LOCATION:C)„Fy,,-,_5 P-~ C~,n C IE.)
Name: (owner) Joh► NNy mot a vso ~.t SUBDIVISION LOT #
System Installer. T+S Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ~Q Public ❑ Well Distance from well t CIJ feet
System Type: =Cl w Types V and VI Systems expire in S yeah.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ma system has been mstaikd in compliance with applicable Nortts Carolina Gen" Statutes, Riles for Sew treatment and Disposal, and aR conditions of the hnprorement Permit and construction Authorization.
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PFRNIT [nNntTinNt-
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No,
If yes, see attached sheet for additional operation co
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ (onventional Other %LN R`~ ~¢6cvea Size of tank: Septic Tank -LO 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch C)_ feet ditches feet ditches_ inches
French Drain Reouired: . JI~Nar
Authorized State Agent RCS _ Date a