OPHTE#Ib-5- V~ Harnett County Department of Public Health 21 510
PERMIT # Operation Permit
New Installation -A Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) -1x11 CNs,(z;uclcCf(ts AN c SUBDIVISION ~'dzc-~-< Qt~.~~s LOT # r) L
System Installer. OT,~, Si ~tw~tAtvD Registration #
Basement with plumbing: ❑ Garage '~k Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well t0 O feet
System Type: -'t~ )2 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.
[his system has been installed in compliance with applicable North Carolina Gen ral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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ACDYIT !'A\I rtITI A\If_
1 VIII 111 \.vl\V111V 111.
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. TPwe-,> L,.,ES Puc~Pd P+,.az,n Ga Homo
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Pyc,%P-S 6 LL
Septic Tank: 100 d
gallons Pump Tank: 14ocj
gallons
Subsurface No. of exact length
width of
depth of
Drainage Field ditcf of each ditch 3a0 feet
ditches 3
feet ditches
inches
French Drain Reauired: Ili fe At
Authorized State Agent o.'r-"j Date 711Z~
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