OPHTE# I r) Harnett County Department of Public Health 21 513
PERMIT # X0-1 Operation Permit
Z New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:1 ►,4 ~E•~t
Name: (owner) C-,-a~q,-e- \VAnns
5 SUBDIVISION -90( Ns Qo.,~ LOT # %a.
System Installer 3o0 F. 5w..q vC- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: lb 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.
tms system has been installed m 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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MMiT fnAnNTINJC•
1. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. 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: X Conventional ❑ Other
Subsurface No. o exact length
Drainage Field ditches of each ditch 60 feet
French Drain Reauired NN- t
Septic Tank: 100 0 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches - 30 inches
Authorized State Agent V~~ J\~~y~~ a>v~s Date 7
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