OPHTE# CrA -5 Harnett County Department of Public Health 2 0 8 5 4
PERMIT #Operation Permit
New Installation ~ Septic Tank ❑ Repair; Nitrification line ❑ Expansion
PROPERTY LOCATION: C`1 P, P~
Name: (owner) Qu &s ,,A w o \~Q kx SUBDIVISION ASAE-v-ow LOT # 105
System Installer: ~o R) C145"N Registration #
Basement with plumbing: ❑ Garage X, Number of Bedrooms
Type of Water Supply: ❑ Commum Public ❑ Well Distance from well 100 feet
System Type: G 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.
o ,p-n iia- ueen wxaueo in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
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 cap ti d property.
Type of system: ❑ Conventional Other Gt+ar.~~l ~~,L c Septic Tank: 100V gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch {50 feet ditches 3 feet ditches 941Y inches
French Drain Required: foot
Authorized State Agent Date 444 I`
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