OPHTE#C'~'s-a$-►~°~ Harnett County Department of Public Health
PERMIT Operation Permit 2 2 4 2 9
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:C_*PQ ES5 Goa UcL
Name: (owner) 0~2.\-~1c~~o,,, SUBDIVISION C-y90-C-5s po>,aN & LOT #
System Installer: JP~oaa C~lKrm 6w5 Registration #
Basement with plumbing: El Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community X 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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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
111. 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 operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage dispo
sal system on the above captioned property.
Type of system:
❑ Conventional Other
G =rj.ow Septic Tank: 1000
gallons Pump Tank: 1000 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches V
of each ditch cad.; feet ditches
feet ditches inches
French Drain Required: t* r feet
Authorized State Agent Date g lb 2.
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