OPHTE#-s-was Harnett County Department of Public Health 2 0 5 3 8
PERMIT # p Operation Permit
I New Installation ',K Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: GE,Qce Vc-", lac. S R~~~t
Name: (owner) oirn~-,-,-~:---~ SUBDIVISION LOT #
System Installer C~c c~ o Laic M~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Be&"s 405Lk s (E yc-fLg
Type of Water Supply: ❑ Community 'I Public ❑ Well Distance from well t O C7 feet
System Type: 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.
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Permit and Construction Authorization
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1. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ OKI
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. ~JPc tl ♦~F`:E URG VN ~co~ fo s~a5ctia X40 Cams ~r3<o s/a scti~C~ S' PE ggb'ar ~ua~~y S ~~E
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Q r^e oNV~Nr t., Kc.~ Septic Tank: 6O o0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ~a of each ditch S feet ditches 3 feet ditches V~ inches
French Drain Required: Line-a-i'feat
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Authorized State Agent Date
North larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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