OPHTE#Q9-s-a:30G2, Harnett County Department of Public Health 21338
PERMIT # a577 5`1 Operation Permit
New Installation ~X Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: W %LL L-uGw
Name: (owner) G S 1-r , G~ o~ SUBDIVISION C.NZ0L\ u A C )AV-5 LOT # 4O
System Installer: ~oaE5 SEi Nf Sezvtc.G Registration #
Basement with plumbing: ❑ Garage Z$ Number of Bedrooms Li
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well kOO feet
System Type: --rTb 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.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: D~ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches y of each ditch 50 feet
French Drain Reauired: pa. roo;~
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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Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent ~ ~ t'L\Y5 Date ~ I n K7