OPHTE# TS—S3 !O°4 Harnett County Department of Public Health 23987
PERMIT # 1'653° Operation Permit
New Installation Se tic Tank �( Nitrification Line ❑ Repair ❑ Expansion
Q PROPERTY LOCATION: Kcssf4L Qijjn!hm Yz
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Name: (owner) R,�V.x� �p�ro2S> SUBDIVISION ES ��%�ct�. LOT #
System Installer: L—aaap-ne Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community :e Public ❑ Well Distance from well Loo feet
System Type: 'FgZ Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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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.
i
44%
❑
D -Box
❑ Pump ❑
Alarm ❑ H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
)< Other R.M V1.0W
Septic Tank: 1C')00 gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
disc
of each ditch 7' feet
1�7
ditches 3 feet ditches inches
French Drain Required:
ear feet
Authorized State hent 'Z"' Date 3123
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