OP RHTE# o"IHarnett County Department of Public Health
PERMIT # Operation Permit 21 7 9 3
New Installation '4 Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nc~ Qt, c'Gw~j 'eD
Name: (owner) S~FF Poet SUBDIVISION LOT #
System Installer: GQw L-~D t~p1-E Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1010 feet
System Type: 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.
II. 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:
❑ D-Box ❑ Pump ❑
Following are the s ecifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditch es~ 3 of each ditch 115 feet
French Drain Required \ ar
Alarm ❑
Septic Tank: I Oo 6
width of
ditches 3
H2011-ine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
Authorized State Agent v\\~ 1'1 v S Date 1--~.1>1\C>
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