OP RHTE# 10 Harnett County Department of Public Health
PERMIT # a ~O ~o Operation Permit 21 5 7 0
New Installation Septic Tank Nitrification Line ❑ Repair 13 Expansion
PROPERTY LOCATION: N
Name: (owner) Cu n•aaQzs-t C, Wd `N C, SUBDIVISION M LOT # S,')
System Installer. Ito Q~) 0-or4 N Registration #
Basement with plumbing: ❑ Garage ~ Number of Bedrooms
Type of Water Supply: El Community Public El Well Distance from well lad 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.
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:
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑
PWR Line
Following are the specifications for the sewage disposal system on the abovff captioned prop
Type of system: ❑ Conventional Other Q~ o%c~'&ErZ l-Q v % c,, L Septic Tank: 10 0 0 gallons Pump Tank: l0 O C) allons
Subsurface No. of exact length width of g
Drainage field ditches a1,t 3 depth of
of each ditch feet ditches feet ditches inches
French Drain Reauired---~
Authorized State Agent w' wv CL&171 Date e)l 2
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