OPHTE# 0 -5 aaa Harnett County Department of Public Health 21367
PERMIT # a53~~ Operation Permit
1 New lnstallation'-)~ Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: 40)
Name: (owner) e-N Q I LLtip,M~i SUBDIVISION W \LL• LOT # L)_
System Installer: R~~~~ccu~ Cp,~R Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public I, Well Distance from well 100 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.
.r- ueen msmieo 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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PERMIT CONDITIONS:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditches _ of each ditch 7 S feet
French Drain Required: I in n#
Septic Tank: 10 C30 gallons Pump Tank: gallons
width of depth of
ditches feet ditches aLl inches
Authorized State Agent ~C--~ Date 41-71 ~ 0