OPHTE# CSR-S-~Z,--7 1~, Harnett County Department of Public Health 21344
PERMIT # 2 ~1 sC Operation Permit
New Installation 'R Septic Tank ❑ RepairA Nitrification Line ❑ Expansion
PROPERTY LOCATION: N,j~~-1 Qo
Name: (owner) Cp„r, SUBDIVISION ~aaoSN~Q.E LOT #I_
System Installer. 17 C- G~~ E2 Registration #
Basement with plumbing: El Garage '7 ' Number of Bedrooms L+ Type of Water Supply: ❑ Community N Public ❑ Well Distance from well mo 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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
with applicable North Carolina General Statutes, Rules for
trt
3(.-Treatment and Disposal, and all conditions of the
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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
Permit and Construction Authorization.
Following are the specifications for the sewage disposal! system on the above captioned property.
Type of system: ❑ Conventional " Other T 10-G C,,,\ , P -5 0 Se tic Tank: V o
Subsurface No. of p G gallons Pump Tank: gallons
3 exact length width of depth of
Drainage field tches of each ditch feet ditches feet ditches
French Drain Reouired: inches
Authorized State Agent_ Date AIq ~ lid
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