OPHTE# Io~S'a~+S Harnett County Department of Public Health 21 5 0 7
PERMIT # X63 \ Operation Permit
New Installation '19, Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1
Name: (owner) AQ (~o..rsn ~`tvc. SUBDIVISION T "C-t-" pwc,G LOT # at
System Installer C-- a pct,-~ S ~a c,ctpC Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _ 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well N00 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for
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Treatment and Disposal,
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional X Other I ,aQ- C.,,\PJ Septic Tank: 100 o
Subsurface No. of gallons Pump Tank: gallons
exact length width of depth of
Drainage Field ditches ,If each ditch feet ditches 3 d^
French Drain Required: feet ditches a inches
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and all conditions of the Improvement Permit and Construction Authorization.
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