OPHTE#9'71 -5 - I°►9 Harnett County Department of Public Health 2 0 8 6 6
PERMIT # Uperatl0n Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1`'e-t1e ILL- Hao~~S (t
Name: (owner) ~l ~y ocr~~ ~ws SUBDIVISION )tE6o0._ LOT # A
System Installer. GL~~c o t✓C Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 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.
ims system nas peen mstaneu 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 L111111 %V11UMV113.
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 2~ feet
French Drain Reauired: ~ltttPaNePf
Septic Tank: 1000 gallons Pump Tank:
width of 3 depth of
ditches feet ditches _
gallons
aL~--71Q~ inches
Authorized State Agent_ Date 'q 'i I ►O
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