OP RHTE# ~o-S-a'-~ aaaP- Harnett County Department of Public Health
PERMIT # aG l A3 Operation Permit 21 6 0 4
I New Installation A Septic Tank Nitrification Line D Repair ❑ Expansion
PROPERTY LOCATION:- -7-v--,ee 6~9
Name: (owner) 5 "-~omL U N L-0 2S SUBDIVISION Pc-a.,s cD,r sn-,4 ,y , ,Ey p LOT # QLqo
System Installer: 1 ~0 CW -4 r- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 'vOC) feet
System Type: 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.
This system has been 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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PFRMIT rnNnITInNC-
I. Performance:
II. Monitoring:
III. 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 ❑ NoX
If yes, see attached sheet for additional operation co
maintenance and reporting.
❑
D-Box
❑ Pump ❑
Alorm ❑ H20Line ❑
Following are the spec
ifications for
the sewage disposal system on the above captioned pro
_
Type of system: ❑
Conventional
Other C.~A P"c`+6 V.A.-
Septic Tank: \ c) a O gallons Pump Tank:
Subsurface
Drainage Field
No. of
ditches
exact length
S ~~`~(each ditch 5 b feet
width of depth of
ditches f
t di
h
French Drain Reouired_
_
1°~~.\
ee
tc
es
-
PWR Line
gallons
inches
Authorized State Agent,_~~~~ ~'~~N-" PLc- " Date 78 13 I)v 6
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