ETHTE 11-5-27113
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Blue Haven Pools Phone 919-465-1965
Address: 400 Dominion Dr Morrisville NC 27560
Name of Mobile Home Park or S/D:
Name of Owner (if different): Robert House
Address of Owner (if different): 1480 Cooper Store Rd Sanford NC 27332
Property Location (State Road name and 1125 Cooper Store Rd
Purpose of Inspection: 24'x36' Inground Pool
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
THIS INSPECTION IS VOID IF:
1. the intended use of the septic system should change, and/or
2. the system should fail or malfunction, and/or
3. the owner or tenant of the property change, and/or
4. after six months
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of
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ist
HTE# Q' - I H4..,ett County Department of Publi, dealth 2 0 4 8 7
PERMIT # 3 > Operation Permit
New Installation ML Septic Tank ❑ Repair E~ Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ /22Z JZ2 Ln ~C'j ,f.-,,,,t
Name: (owner) SUBDIVISION LOT #
System Installer. SAi. &C, <5- Registration # -A
Basement with plumbing. ❑ Garage .fib Number of Bedrooms Z-'
Type of Water Supply ❑ Community tZ Public ❑ Well Distance from well TO feet
System Type: kc C a s 11T 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.
j`Y' 6.- J Z.
This 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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Subsurface system operator required? Yes ❑ No t
If yes, see attached sheet for additional operatoo"
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PERMIT (ONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
IV. Operation:
V. Other.
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maintenance and reporting.
Following are the specifications for the sewa disposa~tem on the above captioned property.
Type of system: ❑ Conventional (Other _ 1 ) R L\,, c s Septic Tank: 2,00 gallons Pump Tank: gallons
Subsurface No. Of exact length width of depth of
Drainage Field ditches of each ditch S 1 feet ditches i feet ditrhat 1 ~C/ ;..A.,
t.
rent ram egwre : linear feet
Authorized State Agent Date I - 0 . L