OPHTE# 177-5-91a'U Harnett County Department of Public Health 24554
PERMIT # V95)'L Operation Permit
New Installation 1< Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -I Li 5 K¢ax•,U-
Name: (owner) MOLL u -q SUBDIVISION LOT #
System Installer: Qoa,t Cit Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: '-rtk.4 L 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 (onstauaian Authorization.
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PERMIT CONDITIONS -
I. Performance: System shall perform in accordance with Rule .1961.
D. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NA
If yes, see attached sheet for additional operation cc
IV. Operation:
maintenance and reporting.
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V. Other. ft w'A. R,,.3 taro 1OR L,J COK,
❑ D•Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field I of each ditch feet
french Drain RequRwl' near feet
Alarm ❑
H2aLine ❑
Septic Tank: 1 000d gallons Pump Tank:
width of depth of
ditches feet ditches
Authorized State Agent_ \y — v \\ ZQA5 Date
PWR Line
gallons
inches
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