OPHTE# 09-5-)LA ~C Harnett County Department of Public Health 2 0 71 8
PERMIT # r~LS_GiV ODeratlon Permit
[New Installation El"' is Tank ❑ Repair Ef*- Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) aS f ,c kw,-tl SUBDIVISION LOT # s
System Installer. 04.'r Registration #
Basement with plumbing: ❑ Garage 0' Number of Bedrooms
Type of Water Supply: ❑ Community C'Public ❑ Well Distance from well feet
System Type: 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.
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win applicable north tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance: Systim 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.. l; ~ 04
Following are the specifications for the sews disposa system on the above ca ioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: /cc gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ;L of each ditch feet ditches feet ditches 071V inrhnc
French Drain Required: linear feet
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