OPHTE# o$-5-a~5~ Harnett County Department of Public Health 2 0 5 4 3
PERMIT # ►-t Operation Permit
New Installation ~K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
p PROPERTY LOCATION: Lpso,%S V-o
Name: (owner) l k. -r~mn B u t t.,Olr j re SUBDIVISION W Ar-~t t7 GaoyE LOT # -
System Installer: 1A.I<E 4Qr,,t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well X60 feet
System Type: -175 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.
ims system nas peen mstaoea in
wim applicable norm Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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wAtNUS C(1avE 02.~vG
1 LIU 111 WIWI1 IV[IiJ.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X Conventional ❑ Other
Subsurface No. of exact length
Drainage Field Itc of each ditch l(n cs feet
French Drain Reauired:~
Septic Tank: rood gallons Pump Tank: gallons
width of depth of
ditches _3 feet ditches 30 inches
Authorized State Agent Date
W A
40
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v 40
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