OPHTE# C--a~ys Harnett County Department of Public Health 20561
PERMIT # Operation Permit
`Q New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: -C`i ~~a fl ~wc,a,, l-N
Name: (owner) SUBDIVISION LOT #
System Installer: Z;,50 WVvIa,C-- w5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of-Bekeents 16`` Mw. MEPL&ip^y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~Ob feet
System Type: V 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 been mstanea in compliance with applicable North Larolma General Statutes, Rules for Sew
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Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes X No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: t u lle 1 Gc. 9g qe~q ET r~ 5y P u mp a E C- !6LA ~Srn Sa
V. Other. Casa, '"~-(X a.P 3000 \
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other P pme-o C'HraneER.Septic Tank: 30a0 gallons Pump Tank: 35~ gallons
Subsurface No. of exact length Qx %It width of depth of
Drainage Field - of each ditch ~xt feet ditches .3 feet ditches I$ inches
French Drain Required: _
Authorized State Agent \\\1~\\\~\: ~ RS Date
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