OPHTE# cFi-5-a ► Harnett County Department of Public Health 21334
PERMIT # a~%oo Operation Permit
New Installation A Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
Name: (owner) y r4, C o ~~ccz v c~~o ~
System Installer: RP+~ oi-I G3o~E~
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well
System Type: c,
(In accordance with Table V a)
PROPERTY LOCATION: P.ococY9,o
SUBDIVISION P, 4,Fcry LOT #
Registration #
3
Distance from well 100 feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
tins system nas oeen mstauea in
with applicable North larohna General Statutes, Rules for Sewage Treatment and
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and all conditions of the
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Permit and Construction Authorization.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No;K'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captionedI ~operty.
Type of system: ❑ Conventional A Other C~a,,,~Erz Qvs~,~ 41 Septic Tank: tfloO gallons Pump Tank: gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Reauired: \ . I%' .'.4t
Authorized State Agent_n" eL- 6s Date 3 1 \`1
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