OP RRRHTE#Q6`S-~~a~ R Harnett County Department of Public Health 21 4 3 8
PERMIT # 7-~`-}S Operation Permit
New Installation ~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: C)-q- ,L->r,$ '~D
Name: (owner) C~~P ~1C~~~ y Cis oK.~bMFS SUBDIVISION o~ecczc~s5 LOT # L~Q2
System Installer. M M -t C~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community _'IK Public ❑ Well Distance from well l0 b feet
System Type X 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.
[his system has been installed 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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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 ❑ NQ-~K
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system onntl a above ca tlo property.
Type of system: ❑ Conventional X Other Pump 1 0 E k1-p\,J Septic Tank: I ObO gallons Pump Tank: 1004 gallons
Subsurface No. exact length width of depth of
Drainage Field ditches ~ \ of each ditch !C)0 feet ditches 3 feet ditches _ t inches
French Drain Reouired: ti
Authorized State Agent Date 5116 ~l()
,51
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