OPHTE# tl - 9/ Harnett County Department of Public Health
PERMIT #-6~ JQ Operation Permit 2 2 7 3 2
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC.
Name: (owner) ~ou~ =~~o,SSF~sv Co r4->" . SUBDIVISION LOT #
System Installer: ~rocxn, c.-,,e- ~cc p95>4 c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a. q
Type of Water Supply: ❑ Community ~ Public ❑ Well Distance from well Ld® feet
System Type: = S9 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 Ireatment and Disposal, and all conditions of the improvement Hermit and lonstruction Authorization.
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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 ❑ Nti
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal I stem on the above captioned property.
Type of system: ❑ Conventional Other Fes- Septic Tank: tdQ)d
gallons Pump Tank: gallons
Subsurface No. of exact length width of
Drainage Field - ditcTies' of each ditch Q feet ditches
depth of
feet ditches )16 inches
French Drain Required: \
Authorized State Agent Date
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