OP RNTE# Harnett County Department of Public Health 241 1 5
PERMIT # r��15C� Operation Permit
,)Iq New Installation �'R Septic Tank IP< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M -LC%, GA"f6j— Cv ut caa Qa
Name: (owner) Mass Ga r+fZ.1� SUBDIVISION LOT #
System Installer: 1 sacL a S'lAot Registration #
Basement with plumbing: ❑ Garage � Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t t1 d feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health 1)3iWrtnant,6 aonth"rior to expiration for permit renewal.
This system has been instilled in ompliance with applicable North Carolina General statutes, Rules for Sewage Treasment ana Disposal and all conditions of the)lmprovement Permit and Commicnon Authorina6on.
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PERMIT CONDITIONS:
I.
II.
III.
IV.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation cc
Operation:
V. Other.
maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the aboy a captio roperty.
Type of system: ❑ Conventional Other �P,"G0 C-�� J Septic Tank: 16 0 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage -14 ditches of each ditch 6 feet ditches 3 feet ditches IV"3 inches
French Drain Required: Linear feet
Authorized State Agent Q�;� 2, Date
1-5-5- 55'Z&L)e-
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