OP RHTE# c%-S-DC_°l(~aV_ Harnett County Department of Public Health 21 4 5 9
PERMIT # Operation Permit
New Installation ~ Septic Tank 0 Repair, Nitrification Line 0 Expansion
PROPERTY LOCATION: Ccz EEC sv,~., L n,L,a,
Name: (owner) \t Y n.4 C.c, <Lv crs Q r i SUBDIVISION Z t_, N O ax5 LOT #
System Installer: ►w.oc%Aor4 Qur,,e,- Registration #
Basement with plumbing ❑ Garage ~K Number of Bedrooms
Type of Water Supply: ❑ Community 1K Public ❑ Well Distance from well G 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.
❑ns srxem nas oeen mscaneo in compuance wim
norm Laronna beneral Statutes, Rules for Sewage Treatment and Disposal, 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 ❑ No1K
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 capti ned property.
Type of system: ❑ Conventional 'X Other Pu«.p` 1 0 r-Zww
Subsurface No. of exact length
Drainage Field ditches 1 o ch ditch a-~ O feet
French Drain Reauired: 'k-,
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Septic Tank: ► o o C) gallons Pump Tank: VO a d gallons
width of depth of
ditches 3 feet ditches 1`Z inches
Authorized State Agent yt>A5 Date 5 bA )1 d
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