OPHTE# 10 C) Harnett County Department of Public Health 21 4 8 4
PERMIT # ~-'9 15 Operation Permit
New Installation ~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LO(ATION: ?6.jQt;4nSP, 'i~J
Name: (owner) C~r.c3eczt~..~ for, s SUBDIVISION CM-4)L-1~tr~' LOT # 9"1
System Installer: I eo ~vAwr,t Registration #
Basement with plumbing: ❑ Garage e)!~ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: 7;~ 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 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:
1. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the sewage disposal system on the abovye captioned pr erty.
Type of system: ❑ Conventional Other CA-,N lQ,u t ~cUc~ Septic Tank: 4 QQ_ gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch la~ feet ditches a11-
feet ditches inches
French Drain Required: 1__ feet
Authorized State Agent_ Date G I ) 61 ld
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