OPHTE# M-s ays Harnett Gounq Department of Public Health 2 0 8 4 5
PERMIT # X5493 Operation Permit
New Installation "N,~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: CtAg_%vs Ns,.,, IZ-L,>
Name: (owner) C z n 'o SUBDIVISION F LOT #
System Installer: JEce ~~~,rYrQso+J Registration #
Basement with plumbing: ❑ Garage ~;K Number of Bedrooms
Type of Water Supply: ❑ Communityl Public ❑ Well Distance from well -10'-" feet <
System Type: 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.
.nn sptem nas oeen mstanea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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PFRMIT rONnITIONt-
and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional X Other ~'L fLy w Septic Tank: too() gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ o ach ditch a50 feet ditches 35 feet ditches inches
French Drain Reouired: _ ~.reot
Authorized State Agent_ ~ Q,5 Date 1/a
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