OPHTE# k0-5- a3 Harnett County Department of Public Health 2 0 8 6 9
PERMIT # spa Operation Permit
New Installation X Septic Tank ❑ Repair 1 < Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ MfLTOU
Name: (owner) Mc,,t-v ~,4 7:yo1A N 5a,4 SUBDIVISION K-oL4 La. LOT #
System Installer: 1 sr.a ) M;'9 t..t? 5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _ a
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t COC7 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.
this system has been installed in compliance with applicable No h Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I I ~ TREbS
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PERMIT rnivnITIANC•
1. Performance:
II. Monitoring.
III. 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 ❑ NOA
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 ~X Other 'r~,cLE C>a ~pS Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches _ feet ditches 44-3O inches
French Drain Reauired:
Authorized State Agent_ p~e~s Date ` 1 aak
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