OPHTE# 10-5-7-3`t3~ Harnett County Department of Public Health 21 4 8 7
PERMIT # --157) 3L Operation Permit
New Installation X Septic Tank ❑ RepairrA Nitrification Line ❑ Expansion
PROPERTY LOCATION: Pot-,oFsL.ost+~rip,,L-
Name: (owner) QQ., Lr,- C -trS _ 1,, L. SUBDIVISION Cn.QoL)+4-F-, Sep---'or-15 LOT #
System Installer: -T $rLr,' .j '~4 Registration #
Basement with plumbing: ❑ Garage, Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t OC7 feet
System Type: ~T t Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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wim applicable north Wolina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the I
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Permit and (onstruction Authorization.
rMill LVIIUMV113.
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 abo a captioned p erty.
Type of system: ❑ Conventional 1 Other C\mN-N0CcL QQy,c,)< yI Septic Tank: 10 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage field ditches r~ of each ditch- feet ditches- feet ditches :).~N inches
French Drain Required: L a
Authorized State Agent Date 6 1l 1