OPHTEAb-5:-5'9a.4Harnett County Department of Public Health 25061
PERMIT # 2�1"1� Operation Permit
New Installation �f4 Septic TankNitrification Line ElRepair ❑ Expansion
r� PROPERTY LOCATION: moa -Olt
Name: (owner) CorQa Pao I` 61 e. S n SUBDIVISION Ro-i 6r, LOT #
System Installer. S a Ll_ H Nr� Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 1�1 Public ❑ Well Distance from well feet
System Type: i= Types V and VI Systems expire in S 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 Staw[es, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 cc
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are thecaspe 'Fitions for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditch ) of each ditch did feet
French Drain Required; '9aear feet
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 1000 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches Q—ZY inches
Authorized State Agent fes-' Date Ifle-) I ) ?
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