OPHTE#_I, O's Harnett County Department of Public Health 21 4 31
PERMIT # 2S`1o~ Operation Permit
New Installation fq Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION _-7'4 6EN
Name: (owner) Q 11-t. C \ko SUBDIVISION IQaNN o r3s
System Installer. L-",qxLj S LOT # a
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well 100
System Type: ~ feet
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.
This 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 Authorization.
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PERMIT CONDITIONS:
I. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
1(,1'
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional Other v~n2"~a lap p Subsurface No. of Septic Tank: 16( 10 gallons Pump Tank: 1600' gallons
Drai exact length width of depth of
Drainage Field ditches each ditch O 4 feet ditches 3
French Drain Required:~~ w feet ditches S~~aLt inches
Authorized State Agent "N~ - ? PD"5
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