OPHTE# 1 1-r5s~~s Harnett County Department of Public Health
PERMIT # a63~7 Operation Permit 21 9 2 0
New Installation's„ Septic Tank ~K Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) \J -Y r,4 <Z~ Ns ,o ,jc^, o 4
System Installer: S NaoctTv-1s -Q t_vCN$tNc
Basement with plumbing: ❑ Garage Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well
System Type: =.5
(In accordance with Table V a)
PROPERTY LO(ATION: Qocs
SUBDIVISION zo~c~zs ~.ocE LOT # \i_
Registration #
Distance from well ®d feet
Types V and VI Systems expire in 5 years.
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:
1. 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:
❑ D-Box ❑
Following are the specifications for the sewage disposal
Type of system: ❑ Conventional Other
Subsurface No. of
Drainage Field ditches 3
French Drain Required:, . Lint
- Pump ❑
stem on the above captioned property.
2- Fua w
exact length
of each ditch Sa feet
Alarm ❑
H2OLine ❑
Septic Tank: ► ®0 0 gallons Pump Tank: _
width of depth of
ditches 3 feet ditches
PWR Line
gallons
inches
Authorized State Agent \~\\y~`\\ 1?t\-1 Date 311?1l
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