OPHTE#. Harnett County Department of Public Health 21363
PERMIT aeration Permit
New Installation )~Z Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Qoca F~c C t'1 u yd Ny L~~
Name: (owner) 1 ~oya~❑v~+to~~ 4~oc~t car SUBDIVISION NE.,..ct,(- LOT
System Installer. (~c&l - 04-0 CAS ~E- _ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well V t) O feet
System Type: ~T c 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.
tms system nas peen mstanea to compnance with applicable North laronna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ewage disposal. system on the above captioned property.
Type of system: ❑ Conventional
Other \.C,t C\' P5 Septic Tank: 1 GO G gallons Pump Tank: gallons
LA\
Subsurface No. of exact length width of _ depth of
Drainage Field ditches of each ditch feet ditches feet ditches_ 'a inches
French Drain Required 44Ka([eet
Authorized State Agent Date ~Jl l 1 ~ o
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