OP RHTE# Qc) Harnett County Department of Public Health 21343
PERMIT # S3 Operation Permit
New Installation Septic Tank ❑ Repair( Nitrification Line ❑ Expansion
PROPERTY LOCATION: \4 s L-t_ Lx)-,%.b V-4--.1
Name: (owner) ~M FvF, aPr,E~ ; SUBDIVISION C- A N ra C%~s LOT # N_
System Installer. ~vN s SS zv~c C Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LOO 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 Treamne2t,,ilnd.Wposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: >_Conventional Other
Subsurface No. o exact length
Drainage field ditches of each ditch 130 feet
French Drain Required: eet
Septic Tank: 1000 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches S inches
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Authorized State Agent Q~w5 Date 31)1110
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