OPHTE# 0c1-r-Harnett County Department of Public Health 21327
PERMIT # ~~Od Operation Permit
New Installation ~K Se tic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~cswEi.t- ~A (Lo
Name: (owner) e-a azx; o e E SUBDIVISION LOT #
System Installer: Q)-, ~e, ~.ca~• ~,~c~ Registration #
Basement with plumbing: ❑ Garage ~K Number of Bedrooms 3
Type of Water Supply: ❑ Community Z~, Public ❑ Well Distance from well kO O feet
System Type: :Z~D 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.
[his 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 Authoruation.
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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 ❑ NX
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: )9~ Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditchess - of each ditch '3d feet
French Drain Reauired: Inn It
Septic Tank: 1O 0a gallons Pump Tank: _
width of depth of
ditches 3 feet ditches ti
gallons
inches
Authorized State Agent ~~~2,4-W Date
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