OPHTE# Q`'11"00 Harnett County Department of Public Health 2 0 5 4 6
PERMIT # a5 D1"9, Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
Name: (owner) b > `L C.L.,--',
System Installer. -Lo,FS Sit-s,c~ Sc ct~,r.E.
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well
System Type: ~b
(In accordance with Table V a)
PROPERTY LOCATION: `T~ N Rfl
SUBDIVISION Qp.~oNs ~oc.a-c LOT # 101
Registration #
3
Distance from well I W feet
Types V and VI Systems expire in S years.
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:
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 ❑ NoM
,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ' Conventional El Other
Subsurface No. of exact length
Drainage Field ditches ) of each ditch {$'0 feet
French Drain Reauired:
Septic Tank: 1000 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches a_ inches
Authorized State Agent ~6 Date q 1 `t
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