OPHTE# � -"31 Harnett County Department of Public Health
PERMIT # 2- 1( ER/New . 0 eration Per it 2 2 2 9 7
N Installation Y Septic Tank YNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a�iyy'1� ° tSFr2
Name: (owner) SUBDIVISION 'O+ x' LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ET Number of Bedrooms 3
Type of Water Supply: ❑ Community L'1 Public ❑ Well Distance from well feet
System Type: , Z b '>Q ; i Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 'r, 1 ?55 6 Ow/her must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa� disposal system on the above captioned property.
Type of system: ❑ Conventional I? Other Septic Tank: 'l gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of i
Drainage Field ditches of each ditch feet ditches ditches inches
French Drain Required: Linear feet
Authorized State Date �l Z!t Z.
u ti
is
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