OPHTE#01--5-92ar13 Harnett County Department of Public Health 21 4 4 7
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PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: PoNDErl-6SP. Vic:,
Name: (owner) Cu the 1U. P,--0 )-'~orf--s L SUBDIVISION S o Ll•,~. 'S LOT # ' ~D---
System Installer: Registration #
Basement with plumbing: ❑ Garage /K, Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Lb feet
System Type: ':;S~)2 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 Deen tnstahea in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
1 L111111 LVI\UIIIVI\J.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. ~v z S-r I Li "S'd CH GG~ FD C> Gcx f~ $ *0
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qu,4)-7-o c rt ,cam ti Septic Tank: Icrc,,-- gallons Pump Tank: 1606 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch d feet ditches 3 feet ditches inches
French Drain Reauired: _ ~w~ax fang
Authorized State Agent ctet-, 5 Date
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