OPHTE# JC7--~-a3 Harnett County Department of Public Health 21 520
PERMIT # 101 Operation Permit
New Installation Septic Tank ❑ Repair , K Nitrification Line ❑ Expansion
PROPERTY LOCATION: P) C.¢a 1o-,, Fa-- eo
Name: (owner) ' rPc.,% L w 1 upEQ-5 SUBDIVISION ppvrs o is Qo 1 a7 LOT # %,,S'
System Installer: SryP.,4GN L.- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms a
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 C)'C> 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.
[his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and ail conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
11. Monitoring:
III. Maintenance:
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.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conv onal Other 4V P I o E Septic Tank: 10 00 gallons Pump Tank to bd gallons
Subsurface No. of act length width of depth of
Drainage Field ditches c~- of e ditch -15- feet ditches 3 feet ditches 30=3 inches
French Drain Reouired: ea
Authorized State Agent 1\ 11~1~ "-r eo~s Date --71 1 x-110
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