OPHTE#0 1-5 a231CA Harnett County Department of Public Health
PERMIT # a61a® Operation Permit 21 7 71
New Installation ~K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) Np ,3s ~ 01-- ^'°UN I--LC,
System Installer: 'DC-Nt-a-'s 'i`1Ec~~1rs
Basement with plumbing: ❑ Garage ❑ Number of Bedroom
Type of Water Supply: ❑ Community K Public ❑ Well
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: vs~o 1
SUBDIVISION LOT #
Registration
PS
Distance from well 100 feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ilus 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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FLU111 WrIUMV113:
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:
Pd n,e ` C~LS~, .
> > a-L ) a Z E. C'' G" <~-D I Arts -TS ' $ uae~z
Fa.v,r c,." "fin p,C~F~
F-1
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the spec
ifications for the sewage dispo
sal system on the above captioned property.
Type of system: ❑
Conventional X Other
u c"~ -7d T-; -Z LOW Septic Tank: e.ao a
gallons Pump Tank: 10 OQ gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch feet ditches
feet ditches 3 0 inches
French Drain Required:
m
' meat
Authorized State Agent Qf.*'5 Date