OPHTE# IO'S-~~~} Harnett County Department of Public Health 21 4 9 3
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairK Nitrification Line ❑ Expansion
PROPERTY LOCATION: L--A-.PrcEcL Q,
Name: (owner) SUBDIVISION ~,.1i tvv-T ~czav F LOT #
System Installer.-ZS--y Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: > 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.
This system has been installed in compliance with applicable North [arolina 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other MIN. , D,-, ~C - `a yc,~.r 3/,A sc~8 p 1 .5 ,1 yQ -
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qv M o o ELY-t-o-~ w M a, ,a: E Septic Tank: S 04 C7 gallons Pump Tank: t 4(30 gallons
Subsurface No. of exact length s o o width of depth of
Drainage Field ditches of each ditch -,,16 feet ditches 3 feet ditches inches
French Drain Required: _ ` b..r)~er
Authorized State Agent e-r--P5 Date 61)`41 16
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