OPHTE# 5-goq,-5 Harnett County Department of Public Health 24827
PERMIT # a`IDC1I Operation Permit
Installation [peptic TankI r (cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IqZ, 8uiko.-d as srr W�7)
Name: (owner) M 6s 14naut.gSa, & 11.:,cL, SUBDIVISION a- T - a LOT # Q3
System Installer: fAv Registration #
Basement with plumbing ❑ Garage E ummbb of Bedrooms 3
Type of Water Supply: El Community LJ ; blic ❑ Well Distance from well feet
System Type: 96`u tt A:.Z-Types V and A Systems expire in S years.
(In accordance with Table V a) Own must contact Health Department 6 months prior to expiration for permit renewal.
Ims 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 Aushorieatian.
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I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage dimes sal system on the above captioned pro erty.
Type of system: El Conventional LJiDther Q it C'Z. Septic Tank: 10 CZ:> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch (A feet ditches feet ditches 90 inches
French Drain Required: Linear feet _ y
Authorized State Agents %�.�� Date 11 112t 0 i
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