OPNTE#Harnett County Department of Public Health 2 0 7 8 7
PERMIT # operation Permit
New Installation Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) C~ ~t n w~ND ~~t,, 5 SUBDIVISION ~stf=FV LOT # P _
System Installer. __7iQ ' 6"w N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public 1~k Well Distance from well OQ feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
17-111 ❑a ueen msranea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
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Permit and Construction Authorization.
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.
Following are the specifications for the sewage disposal system on the above captio ted property.
Type of system: ❑ Conventional A, Other K.6 rlQ~ticrc' 1°N 14Q&'$ Septic Tank: t066 gallons Pump Tank: gallons
Subsurface No. of exact length P@rs `"'N width of
depth of
Drainage Field ditches ~ of each ditch 7.5 feet ditches
French Drain Reauired:n~ \ \ li~~l r -feet ditches Q_ inches
Authorized State Agent
11.5 Date 'Z (121 e, -1
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