OPHTE# O°►~5--3`~9a, Harnett County Department of Public Health 21 4 5 0
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LO(ATION: Nao~tESZ Ra
Name: (owner) to. iC r Q,Eq-,cr_ )t,4 c, SUBDIVISION ?EMS1r M0N LOT # 1j_
System Installer: i ~ ES cam,,,, N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10 0 feet
System Type: 3= 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.
finis 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:
I. Performance:
II. 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 ❑ 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 Pun~"To aS1o
~2
Subsurface No. of
exact length
c Tank: 100U
p
id
h
1f#QG
gallons Pump Tank: gallons
Drainage Field ditches
French Drain Reouired: _
of each ditch S6o feet
\ \ l,n - a
w
t
of
ditches 3
depth of
feet ditches 1
inches
Authorized State
Date 511
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