OPHTE# ii C) -s-;k-X a- Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 51
New Installation 'K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: es
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Name: (owner) C~ m ~Fsu_ry. a~ W o mEs SUBDIVISION C ~na~ nom, S~~N LOT # 19 System Installer. =F-p gci-ow rj Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well feet
System Type: ti > 1 g 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 CONDITIONF
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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
❑
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the specifications for the
Type of s
stem: ❑ Conventi
l
ewage disposal system on the above captioned property.
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Septic Tank: 100 G
allons Pu
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: gallons
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sur
ace
Drainage field
No. of exact length
ditches of each ditch 1 Zo feet
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width of depth of
ditches feet ditches a~ i
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French Drain Required:
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Authorized State Agent_~,~~~ RL Date to (1 N 0