OPHTE#~., Harnett County Department of Public Health 21 51 4
PERMIT # Operation Permit
New Installation ~KN Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: l-~ CZ 'vA
Name: (owner) C.v~~2i Rio \Ad-a 1•,C, SUBDIVISION M tc E,tvC~~ LOT # VAM
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System Installer. 'REV 9> o'w Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =a 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.
!his system has neon installed-in 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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?FRNIT rnunITIAW.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
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 ab ve captioned p erty.
Type of system: ❑ Conventional Other Septic Tank: 16 t°~ C, gallons Pump Tank: gallons
Subsurface of exact length width of depth of
Drainage field ditches of each ditch I feet ditches feet ditches all "34 inches
French Drain Reuuired Ilxiar`fntat
Authorized State Agent ~~5 Date 7
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