OPHTE# O Harnett County Department of Public Health
PERMIT # _G It-Z Operation Permit 21 61 Q
New Installation ~ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: QL~ E
Name: (owner) u P M E SUBDIVISION THE Sv M ~-c LOT # t
System Installer: 0-T s S-c Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community `S~ Public ❑ Well Distance from well t00 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.
tnrs 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 rA&lnITIAUC•
I. Performance: System shall perform in accordance with Rule .1961.
11. 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.
S ; Eppow iv P :
20 , N a
L-oc,0.C ED ~ . 9~ec cL Qv u b s
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned
property.
Type of system:
❑ Conventional Other
V: Vt-0--
Septic Tank: t 0C_'() gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches l
of each ditch )LA 0
feet ditches 3 feet ditches
inrhac
trench Drain Required: ear feet
Authorized State Agent ~t~5 Date 9 sp
-
3
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