OPHTEHarnett County Department of Public Health 21240
PERMIT # a-5~ 65 Operation Permit
New Installation X Septic Tank ❑ Repair,X Nitrification Line ❑ Expansion
PROPERTY LOCATION:-. Wit-r. V-.c,
Name: (owner) 9-,~-,me,g-,P,Clo SUBDIVISION k1N1-o,,,, LOT # 2a
System Installer: _ QO7 ~s Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 14 Q feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
with applicable North (arolina General Statutes Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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PERMIT CONDITIONS:
L Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X' Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches f each ditch 5 feet
French Drain Reouired: _ t
Septic Tank: l oo 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches -5,q inches
Authorized State Agent Date 1 20~ 1
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