OPNTE#09-5-a09I a Harnett County Department of Public Health 21 51 7
PERMIT # ~503~ Operation Permit
New Installation 'N. Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: C.Qze'~vILLE C,,, ya.c.N 9,p
Name: (owner) SS QC1 oef SUBDIVISION 5.P-) L1 N O a~S LOT # 17
System Installer: -Z3-c-- S') \T-~ 2\ Lx-~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
this system has been installed in compliance with applicable North Carolina General 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.
11. Monitoring: As required by Rule .1961.
111. 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 s stem on the above captioned property.
Type of system: ❑ Conventional Other Z !FL\,j
Subsurface No. of exact length
Drainage Field ditch"s,, of each ditch D.30 feet
French Drain Required: \ to
Septic Tank: t ooO gallons Pump Tank: gallons
width of depth of
ditches .J feet ditches I inches
Authorized State Agent J ~l y6
Date
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