OPHTE#t5-5 3-7)'0 Harnett County Department of Public Health 23979
PERMIT # a'$5y3 Operation Permit
New Installation 'R Septic Tank Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: FAa.co"4 IZD
Name: (owner) VJWe(1f �wC1 a, A -QV EL. SUBDIVISION LOT #
System Installer. 1-0 ev+a , C J o xA tv 5 tl ij Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3 -N
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t 00 feet
System Type: a Types V and VI Systems expire in S 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 (commissions Authorization
NomE
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rtnnu wnumuru:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El
Conventional Other EyZ V -Lo -4.
Septic Tank: 160 O
gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field--ditehes.�
1 of each ditches -40 feet
ditches 3
feet ditches inches
French Drain Required:,
wear feet
Authorized State Agent Date
1S-5-3- 1%y
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