OPHTE# f o-Sa OLiC~ Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 6 2
New Installation X Se tic Tank X Nitrification Line El Repair F-1 Expansion
PROPERTY LOCATION: ON_rV_e.O,sa
Name: (owner) G' uM¢~FS2 a-C~t~fl C~OhE~ Nc SUBDIVISION CArze~~rvp, SEp,z6sv5 LOT # aL
System Installer: FS~ 82owr► Registration #
Basement with plumbing: 11 Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 00 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.
This 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are th
e specifications for the sewage disposal system on the above captioned pr
Type of system:
❑ Conventional Other
GA Ac~B~ ~Qv sC:<IA 1
Septic Tank: SAO G gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 4
of each ditch feet
ditches 3 feet ditches a'i inches
French Drain Required: Linear fe
Authorized State Agent ~~''S Date ~4
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