OPHTE# 4)~-s = ,337z/ Harnett County Department of Public Health 2 0 9 0 6
PERMIT # zS?10 Operation Permit
2( New Installation L1J Septic Tank ❑ Repair Ey Nitrification Line ❑ Expansion
PROPERTY LOCATION: .vr.~syy r"'-z r/q)
Name: (owner) 6;, z SUBDIVISION j,,2 . 2. e-v r LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community IJ Public ❑ Well Distance from well feet
System Type: s_A,0, Zr 6. G-z rat 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.
ems syrrem nas peen mstaneo in compliance with applicable North Laroltha General Statutes, Rules for Sewage Treatment and Dispo:
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and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other 15°1o 126)ycr", Septic Tank: -10 Q 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches L of each ditch lZ o feet ditches feet ditches inrhac
French Drain Required: Linear feet
Authorized State ent Date 3 - Jy
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