OPHTE# /cZ -5-- a2- &~QS- Harnett County Department of Public Health
PERMIT #a 30 0 eration Permit 2 21 9 5
B" New Installation Septic Tank C' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C;00 J;s4-.
Name: (owner)~,~e,--~ : aj~j-~ SUBDIVISION LOT #
System Installer: (34-4=I' ~>r•-:cle t ~P Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms -7
Type of Water Supply: ❑ Community Kf Public ❑ Well Distance from well feet
System Type: "uz q-- 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 has been instaue0 in compliance with applicable North t.arohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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 ❑ Pump ❑ Alarm ❑
Following are the specifications for the seewwardisposal system on )he above captioned property.
Type of system: ❑ Conventional I._t~' Other C- .~~EL., Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches q of each ditch feet ditches _
H20Line ❑ PWR Line
JUO gallons Pump Tank: gallons
depth of
feet ditches a inches
french Drain Required: Linear feet
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Authorised State Agent. 141
Date 2~ Z
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