OPHTE# Harnett County Department of Public Health 19925
PERMIT Owation Permit
X New Installation V Septic Tank ❑ Repair,K Nitrification Line ❑ Expansion
PROPERTY LOCATION: 5"
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Name: (owner) S (nsEp r+ ~ o.kA SUBDIVISION R 00LS.-i LOT #
System Installer. M ~v-r-- CZ~.y Registration #
Basement with plumbing: ❑ Garage'. Number of Bedrooms 3_
Type of Water Supply: ❑ Community 'T2( Public ❑ Well Distance from well feet
System Type: ITTr Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis System has been imtaYed in COM02M with cabk North (Mhaa Gen" Sututes, Ituks for Sewage Treatment and Disp J, and au castd6 m of the bn aemmt Permit awl (omtructims Audsofju6 .
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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
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 captioned property.
Type of system: ❑ Conventional Other Qar~st te~U~c Pie Septic Tank: 100 gallons Pump Tank: gallons
~'~Size of tank: Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch c~ feet ditches 3 feet ditches S g -Z inches
French Drain Reouired _ r,..,. f...
Authorized State Agent ~25 Date t