OPHTE# 10-0 Harnett County Department of Public Health 21 4 4 9
PERMIT # Operation Permit
New Installation '~K Septic Tank El Repair ❑ Nitrification Line El Expansion
PROPERTY LOCATION: Kei,-~Ez. Ble,
Name: (owner) Si)aW C6rrsf 1 Ca,(,, SUBDIVISION LOT # 5
System Installer cti~ L G G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t0 O feet
System Type: 0'- r N p`"i k4" 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.
nm ~ruem nas ueen mstanea in compnance wim applicable north larolma General Statutes, No 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 ❑ No ❑
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 ❑ Other
Subsurface No. of exact length
Drainage field ditches - of each ditch feet
French Drain Required:. v~- et
Septic Tank: S Ci0 Q gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent Date 51)5/0
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14
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Y