OPHTE#-I Q- 5-a14 000 Harnett County Department of Public Health 21 4 4 0
PERMIT #Operation Permit
New Installation Septic Tank El Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: NL-P1 4 F- 7')
Name: (owner) Cu MM Nn 6 5 SUBDIVISION Sj r) r, c N LOT # W
System Installer: O-T,5 ell ~c ww Registration #
Basement with plumbing: ❑ Garage 4 Number of Bedrooms
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well IOC) 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.
[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: System shall perform in accordance with Rule .1961. ,
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
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 X Other t. Z-- Flow Septic Tank: ~ QC7 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Z d feet ditches feet ditches a inches
French Drain Reouired:Pt
Authorized State Agent N"\ gc-k Date 51)"110