OPHTE# I o -s_a3~~ ► Harnett County Department of Public Health 21 5 01
PERMIT # 25~►03 Operation Permit
New Installation X Septic Tank ❑ RepairA Nitrification Line ❑ Expansion
PROPERTY LOCATION: L-ASS,: (Zb
Name: (owner) ~2~w„~~,uNsa>J ~u~~ oc-n,s SUBDIVISION (;2c,-j6_ LOT #
System Installer. G EN f- F~ o, c,~ ~~o+✓ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well V 4 C) feet
System Type: 7Z~ Type V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Healt Department 6 months prior to expiration for permit renewal.
t
mis system has been installed in compliance with applicable North Carolina G eral Statutes, Rules for Sewage Treatment Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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 ❑ No
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 caption roperty.
Jjo~
Type of system: El Conventional Other C-H tSM
L. Septic Tank: 1 b O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch ~~,C~ feet ditches 3 feet ditches 1
French Drain Required: inches
Authorized State Agent REwS Date 6 I ~i~ I ) 0