OPHTE# 60 Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 8 4
New Installation Septic Tank '~X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '~s7 l-ycQ.~ Rte
Name: (owner) SUBDIVISION LOT # 15
System Installer: ~o~tEs Ste` c- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t00 feet
System Type: = e_ 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
North Carolina beneral )tatutes, rules for )ewage Ireatment and msposal, ana all conanlons of me improvement rermn ana tonstru t= Rutnonzatlon.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 'f'`
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned prope .
Type of system:
❑ Conventional Other
Cr1tAm` fit `Q.v~c.^~ ~-l
Septic Tank: A 64n gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 1
of each ditch 1 0 feet
ditches 3 feet ditches c~c 1 °3t5 inches
French Drain Required: Liam feet
Authorized State Agent -i'S Date ) s )0
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