OPHTE# tO-5.a4~0~ Harnett County Department of Public Health
PERMIT # s~ Operation Permit 21 6 3 0
New Installation 'K Septic Tank k Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: B~ .Ld Lp,.~~ 14
Name: (owner) Co c::-\ \ oN SUBDIVISION LOT # 13
System Installer: R~,N~y `i Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \00 feet
System Type: '.L 1 lr~ 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.
> >rimm oar ueen mszanea 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:
II. Monitoring.
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other. wr ALnGLrn S-V t ~t ~o ~i G~c~t
d 0-~-W V D-Box ) Q Pump 3'j Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property .
Type of system: ❑ Conventional Other Pu rnP_'~a CA\Pr•,e,c-s?_ Q Septic Tank: to <,:!)O gallons Pump Tank: 1 c(750 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 5n
feet ditches 3 feet ditches 1B X11 inches
French Drain Reauired:,r
Authorized State
\4_5 _ Date 0 -)110
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