OPHTE# 1 O - 5--.13c*C-1') Harnett County Department of Public Health 21480
PERMIT # 2584 1 Operation Permit
New Installation Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Rc QN E.
Name: (owner) ( y t,-, m N a G 5 SUBDIVISION S y tY, c-. s-C LOT # 1-3
System Installer: O i s S-TQ.N ,•c P, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~9 Public ❑ Well Distance from well 100 feet
System Type: - Types V and VI Systems expire in 5 years.
(In accordance with Table V a) u. Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims 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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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other C-2-- ~1 ow Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc 3 _ of each ditch 50 feet ditches 3 feet ditches r-ky inches
French Drain Reouired:w I in t
Authorized State Agent ~ ~ 2~ Q,qN-'6 Date r,, 1 -1110
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