OPHTE# CH-:).o Harnett County Department of Public Health 21260
PERMIT Operation Permit
New Installation X Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION: I"1, ~ lavFn R~
Name: (owner) s-rpkNG1 u,moo ys 1N SUBDIVISION VA' oa5 Pos _ LOT #
System Installer: ~a,,,c-\ t_ Registration #
Basement with plumbing: ❑ Garage' Number of Bedrooms --3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Boa 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.
[his 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:
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 operation co
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other CZ Ft,ew Septic Tank: 1 o n gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 1 /
Drainage Field ditches of each ditch 150 feet ditches -3 feet ditches C 4-3-Z inches
French Drain Required: '`tiraear fans
Authorized State Agent 2L- o1 ' Date I I?