OPHTE# a~-57~ 3 Harnett County Department of Public Health 21257
PERMIT # Operation Permit
New Installation '4K Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION p',,.~>sE ~„fl
Name: (owner) s¢.~. L v c,vs Cc, SUBDIVISION Sv ace, S~3 LOT # _
System Installer77~Q'(LO-4 .t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t o o 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.
finis system bas 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:
II. Monitoring:
111. 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 ❑ No
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 Giaa~ ~Q ,Uc IN F YL- Septic Tank: L GO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch as feet ditches 3 feet ditches ;LLA ~ inches
French Drain Required: _ fimeaaar
Authorized State Agent R-~ 5 Date
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