OPHTE# 10 -,J-- 'Z *2,3 Harnett County Department of Public Health
PERMIT t Operation ermit 21 5 3 7
Qf New Installation F' Septic Tank 0- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a
Name: (owner) nn Ca.. s~r~c a SUBDIVISION 7-,`-1 ! oo t LOT # 41
System Installer: o.1 4,1 .611'f -.1 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community P""Public ❑ Well Distance from well feet
System Type: 7 -77 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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1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. '1,4A, 4( F-kG4 3/,~Jl
❑ D-Box ❑ Pump ❑ Alarm H20Line Id PWR Line
following are the specifications for the s disposal system on the abo a captioned property.
Type of system: ❑ Conventional ewaOther vEck q C~tLA• 6 t~ Septic Tank: WO gallons Pump Tank: gallons
Subsurface o. of exact length width of depth of
Draina a field ditches of each ditch 9a
g ~ feet ditches feet ditches 3 'A9 inches
French Drain Required ~ d j I"
Authorized State Agent ~ ~~~~~~y~c•>,S _ Date 9
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