OPHTE# Ce-Harnett County Department of Public Health 2 0 8 3 7
PERMIT # Operation Permit
L' New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: N G WA
Name: (owner) OouGL9s \YiN"INE `t'`1aHwr~ SUBDIVISION LOT #
System Installer: M Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community -A Public ❑ Well Distance from well feet
System Type: o. Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
tms system nas peen mstanea in
with applicable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consttuction 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:
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional 'K Other 1 \Q.E CAA x-PS Septic Tank: s M 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 15O feet ditches 3 feet ditches a'-t inches
french Drain Required: _ ar feet
Authorized State Agent
\ e-5 Date
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Central Ca-folina Holds g LL Dates 7/14/2009
firoev 1-4:07-.59 - 14:30t:25
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100% u t N2 I'f2 .i rtic h UFM Ton *22. 0fUn $220. 00
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Thy !nnn ~t ti e is from the Fuel Grade location and meets the Ne: aclf4C0tIOn
hstewdter syst~ m approval IWWS- 2002-03R for the chip
rttb~lliwlon to R"j jgteVate 1n filliriflCatlon field.