OPHTE# I C) -Harnett County Department of Public Health 21 4 4 4
PERMIT S Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 9,ec-s-r-s c-y \-'~o SUBDIVISION rY ~~o LOT #
System Installer. QKtoW ~j Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well YbQ feet
System Type: CA Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No~K
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 )perty.
Type of system: ❑ Conventional "X Other ~a, LQv7 L~ Septic Tank: X600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ~f each ditch C-0 feet ditches 3 feet ditches inches
French Drain Required 'fit, ro.
Authorized State Agent "-N ~ +5 Date S 1 a1
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