OPHTE#- N0-5-9n Harnett County Department of Public Health 21 4 8 5
PERMIT # 04 Operation Permit
New Installation 1 Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1 c~...r 'Rs7
Name: (owner) PQ ~ar~ SUBDIVISION 'I ►,~6E,,, Qt.~,c~ LOT # V_
System Installer. S-i ov-t.Q E. Registration #
Basement with plumbing ❑ Garage ~K Number of Bedrooms - 3
Type of Water Supply: ❑ Community 14, Public ❑ Well Distance from well } o o feet
System Type: `ZZ D 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.
ims s rem rw oeen mscanea in compuance wim appucabie norm larobna tieneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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AMIT CONDITION(-
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)<
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other. T'i(,E. Gti 1% p Septic Tank: 10 0 0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S ~ feet ditches feet ditches 3 3 -a't inches
French Drain Required: Nr feet
Authorized State Agent ~ ~ g~k~S Date
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