OPHTE# t o a°~ Harnett County Department of Public Health 21 4 4 2
PERMIT # Operation Permit
New Installation ~l Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: RcL~~s
Name: (owner) 1~6 Lta c,-4 z--L- ``A o m ~S SUBDIVISION LOT # 4s`T
System Installer: QT ~_s 3ci.-,~ ~L~,, Nq Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community '~K Public ❑ Well Distance from well 144 feet
System Type: 12 Nl~ 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.
❑m system has peen mstaneo in
with appncaule north larohna General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authorization.
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I. 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 N1GcO t5,~~ss Sos> C~o sSUW<c iC 6 ~lo0M1 --Vo ~EE# ~ti1S~7 ~ySY~r d r ~,-E
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Following are the specifications for the sewage disposal V stem on th above captioned property.
Type of system: ❑ Conventional Other ~U a EZVlow Septic Tank: S 0(IQ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch @~30 feet ditches J feet ditches inches
French Drain Reauired: T..r
Authorized State Agent Date 51 ~ 416
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