OPHTE# 10-5---'b Harnett County Department of Public Health
PERMIT Operation Permit 21 8 5 9
New Installation ) J Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PoNOE2o5U.
Name: (owner) Cjr,Osz,L-P,-o 'AnMtrS\~~_ SUBDIVISION CA2ouN~, 5o~,s LOT # 1I
System Installer: \ c-o $<2-o w ~t Registration #
Basement with plumbing: ❑ Garage '5Q Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 106 feet
System Type: `~11 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.
Ihls system has been installed in
with applicable IVdrtn Lamina tteneral itatute5, Mies Idl
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SQ~bN 6 ~yowFltS ~ Treatment and ulsposal, and an conditions or the improvement rerm¢ and construction Nutnonzation.
36'
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t
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the ab ve captioned p?~erty.
Type of system: ❑ Conventional Other G>>~.4. 9 j-, I / Septic Tank: 100 01 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch I_,)_0 feet ditches 3 feet ditches Z14"3
French Drain Required: _ _ ~ rnwpar
PWR Line
gallons
inches
Authorized State Aeent\\~' - "I- VU-A§ Date k