OP RHTE# 10 '5-00, Harnett County Department of Public Health
PERMIT Operation Permit 21 9 5 3
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L oce Vtp
Name: (owner) ~At nE5 .y~5 SUBDIVISION N(k a ~ VW-L.." LOT #
System Installer: C}c» S°cra~r;tiv,ac) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3-
Type of Water Supply: ❑ Community 'CX Public ❑ Well Distance from well t C70 feet
System Type: 'fib 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.
Ihis 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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YCn1911 LILINUIIlUNY
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)gf
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
-1-10' Sv4QL-1 L1NE-
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:~Conventional
Subsurface No. of exact length
Drainage Field ditches of each ditch X50 feet
French Drain Required: Linear fee
Alarm ❑ 1-1201-ine ❑ PWR Line
Septic Tank: 100 Q) gallons Pump Tank: 1O Q4 gallons
width of depth of
ditches 3 feet ditches bl~ 1 inches
Authorized State Agent 2a:~'\5 Date 5 1`11 )
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