OPHTE#Q,-5A511i Harnett County Department of Public Health
PERMIT # 0-6C%5- Operation Permit 2 21 8 0
Tank;' Nitrification Line ❑ Repair ❑ Expansion
X New Installation ~K SCNS*4
h PROPERTY LOCATION: ~ocrc
Name: (owner) Q)S%aN S G- SUBDIVISION LOT #
System Installer: J c5 \n tJ 'i) NESC-'C';~ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well M0 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.
This system has been installed in compliance with
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2P+y Ems 20 Cad. CLO
North Carolina General Statutes, Rules for Sewage treatment and Disposal, and all conditions of the improvement rermut and t.onstructnon nutnorizahon.
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PERMIT CONDITIONS:
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
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
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maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z. Fs-o-"' Septic Tank: 1 CX~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches `z.. of each ditch ~d feet ditches 3 feet ditches ~g^cl, inches
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French Drain Required: Linear
Authorized State Agent ~5 Date 4~)D)4)D_
77
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