OPHTE# 1C~ ` 2ta✓l )I Harnett County Department of Public Health
PERMIT # Ol' Operation Permit 21 9 3 4
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: gC,s~~~L $Pg-c YD
Name: (owner) C a5~~`i 1L-1-~ SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public X Well Distance from well bC) feet - Exis~tr+ e SELL
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.
Itus 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 )K/
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If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
following are the sp cifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditche_ s```-9 of each ditch feet
french Drain Required:- a \ ' ar feet
Alarm ❑ 1-1201-ine ❑ PWR Line
Septic Tank: 10CQO gallons Pump Tank: gallons
width of depth of
ditches- feet ditches inches
Authorized State Agent ~`5 Date