OPHTE# Io - S- 'ti- C) " Harnett County Department of Public Health
PERMIT # Operation Permit 21 6 3 2
New Installation '-FZ Se tic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~a~„of6p.
Name: (owner) SUBDIVISION Cot_t~'~ Saar LOT # t4 1
System Installer. mow Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ~
Type of Water Supply: ❑ Community 'DR, Public ❑ Well Distance from well COb feet
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.
'p"", "I ueen msraneu in
wrtn applicable north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system ~ the above captioned property.
Type of system: ❑ Conventional Other ~O-e ° r~c~~rZCQ~,c v1~ Septic Tank: 1(5 0Q) gallons Pump Tank: 3 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ao feet ditches feet ditches a 9 inches
French Drain Required: e n \ N inner feat
Authorized State Agent y!~> ,eL1 Date 9Ia~ 110
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