OP RRRHTE #ll -51 M Harnett County Department of Public Health 23993
PERMIT # argrl2. Operation Permit
New Installation Septic Tank )!� Nitrification Line ElRepair ElExpansion
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PROPERTY LOCATION: 1") cUov6wLZ 9Z
Name: (owner) Moss loc+G$vswF1Tb SUBDIVISION Svc MEXX'%s>—L LOT # 1 T
System Installer. PLjEnA Mos5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10!Z) feet
System Type: �l11.c_ Types V and VI Systems expire in S 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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❑
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Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal s
stem on the above captioned property.
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D71 L7h�
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Septic Tank: SSL gallons Pump Tank: gallons
Subsurface No. of
MC-.ro'F
exact length
width of depth of
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I
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rtNMlI LUNDIIIDN):
I. Performance:
11. 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 ❑ No
If yes, see attached sheet for additional operat n conditions, maintenance and reporting.
❑ D -Box
❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal s
stem on the above captioned property.
Type of system: El Conventional
Other _
_i—An„4
Septic Tank: SSL gallons Pump Tank: gallons
Subsurface No. of
exact length
width of depth of
Drainage Field i itc es
of each ditch a.1 0 feet
ditches .3 feet - ditches � 3 0 inches
French Drain Reauired: _
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Authorized State Agent —� y RW Date
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