OP RHTE# 10 - S-3JL1t~3rJR, Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 5 9
New Installation X Septic Tank '~K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: O
Name: (owner) NFS z~~y ~,S,oM V\omE.S SUBDIVISION
-SyTo ~c,ss LOT #
System Installer: b!hy, r cl V cu.j ~ N.5 Basement with plumbing: ❑ Garage Number of Bedrooms ~egistration #
Public of Water Supply: ❑ Community
System Type: ❑ Well Distance from well t 00
y feet
S
(In y accordance with Table V a) - Types V and VI Systems expire in 5 years.
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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St
o r
PvKR ` t o
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
t1~'
❑
D-Box ❑
Pump E)
Alarm ❑
H2OLine ❑
Following are the specifications for the sewa
ge disposal system on the above ca
tion
d
PWR Line
Type of system: ❑
Conventional
p
e
property.
Other E -2 1PLo,,,,
Subsurface
No. of
exact length
Septic Tank: t000
gallons Pump Tank: gallons
Drainage Field
French Drain Re
uired
ditches
~
of each ditch ` feet
width of
3
ditch
es
depth of
feet dit
h
x4-3
q
:
L n et
c
es
0 inches
Authorized State Agents
Date