OPHTE# Ch's-~.O~a3 Harnett County Department of Public Health 21 4 6 0
PERMIT # 2-SOa.~ Operation Permit
New Installation See Ptlc Tank ❑ Repair,X Nitrification Line ❑ Expansion
PROPERTY LOCATION: L-e E~~sY t_t_E G, s ct c ~a R~o
Name: (owner) S P2 n P ErL,-5 ~,5 SUBDIVISION S e. L, O AxS LOT #
System Installer: 1s,orr,SON5 9 ",M41 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: T b 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.
lms 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other PV e, -"G P-'2„ Septic Tank: X00 6 gallons Pump Tank: N 008 gallons
Subsurface - No. of exact length width of depth of
Drainage field ditches _ oof each ditch X50 feet ditches 3 feet ditches 1 a inches
French Drain Reauired: ar fPP\
Authorized State Agent czc8„5 Date 5k~z,~ 1.0
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