OPHTE# 0g-sHarnett County Department of Public Health 2 0 5 6 3
PERMIT #Operation Permit
New Installation 'X Septic Tank ❑ Repair 't5~ Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) $ssaN0\ MCC" 4f--LL SUBDIVISION Ovvc,A~ I-s ~4 LOT # _
System Installer. Ot-" ",s Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well G~3 feet
System Type: h 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.
11m lrxeni Has ueen mscaneo in compoance wim appocame north laroua t,eneral Statutes, Rules for Sewage Treatment and
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,l/. warEills•~~ 'S c ze-~ $7-p i7 w~-re
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and all conditions of the Improvement Permit and Construction Authorization.
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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other T~~~ E Daa~~~~~~~fl Cwt c9 QU 09 , 6uPgry L\NL- 'Vt7orr, gR09 Et -j'0 Zi,a' Es\S
S-" Z -70 ~t C~~~ CYEO. Pll P P LF2M st x `Tv P>L C~AC-_ 7
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qu~4 1 U C__1 c~~ o v Septic Tank: V 00 (7~ gallons Pump Tank: 1 pp(~ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 9 d feet ditches feet ditches _5S- W inches
French Drain Required: ALh►ear feet
Authorized State Agent NX\_ CIS
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