OPHTE# SO' 5 a t45 Harnett County Department of Public Health 2 0 8 6 0
PERMIT # Operation Permit
New Installation Septic Tank El Repair'X Nitrification Line El Expansion
PROPERTY LOCATION: 1lW-4 2.~
Name: (owner) SUBDIVISION 1 %'loNUz E LOT # S t 0
System Installer: \AoLa.P•Np Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~C)O feet
System Type: 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.
ims system nas peen mstaueo in
and all conditions of the
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Permit and Construction Authorization.
1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ NoX
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: ❑ Conventional Other E--.. -w-,
Subsurface No. of exact length
Drainage Field ditches of each ditch I `Z feet
French Drain Required: L*ar feet
wim applicable North 6arolma General Statutes, Rules for Sewage Treatment and
Septic Tank: 07300 gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
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