OPHTE# 10 -s-ay oso Harnett County Department of Public Health
PERMIT # (oft Operation Permit 21 6 01
p New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: Noov~Q_jD
Name: (owner) U Q3 e) u x- o sc,._S SUBDIVISION P~~„MM O N VN) LL LOT # L'Qp
System Installer: ► Go E ~ ti Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t0 C~
System Type: Z~ feet
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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type system: El Conventional Other Pp P 1
C4 ~~,L Septic Tank: EOOQ gallons Pump sank: ~6013 allons
Subsurface No. of exact length width of g
Drainage field ditches depth of
of each ditch S feet ditches 3 feet ditches
inches
French Drain Required: ~ feet"-,,,
Authorized State Agent 2k>06 Date q