OPHTE# (U Harnett County Department of Public Health
PERMIT # `613`1 Operation Permit 21 6 4 7
New Installation 'P~ Septic Tank 14 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ca„vErLar, kI
Name: (owner) Cv n,aEc~.w...sp \ci m iz-.6 SUBDIVISION LOT # N'3
System Installer kEO 8czy,,N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well BOO 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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PERMIT rflunlTIANC.
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other pvr -P'So CV\r.rt%t rZ. CQa0t y- Septic Tank- 1000 gallons Pump Tank: 14O6 gallons
Subsurface No. o exact length width of depth of
Drainage field ditches of each ditch 1 f- O feet ditches 3 feet ditches inches
French Drain Regbl~ feet
Authorized State Agent : pZ-,~5 Date , ,I )ZI ) U
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