OPHTE# d4-Ss=Za3C0 Harnett County Department of Public Health 2 0 7 0 5
PERMIT # a S ST(V Operation Perit
New Installation E Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: 82.7 tJ Q44-
Name: (owner) ! 1 c c WoN.e- J'/,- SUBDIVISION LOT # 72
System Installer. /'e.C, J"; an Registration #
Basement with plumbing: ❑ Garage V tuber of Bedrooms 3
Type of Water Supply: ❑ Community c El 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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PERMIT CONDITIONS:
wan applicable north tarouna beneraf )tatutes, Rules for kwage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authonzation.
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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 L~
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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Following are the specifications for the sewagp disposa~system on the above ca boned property.
Type of system: ❑ Conventional L' Other y,tn p f o G Z ~~o w Septic Tank: 000 gallons Pump Tank: / 0 U 0 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch oZ (,v feet ditches 3 feet ditches 8 inches
French Drain Required: feet
Authorized State Agent ~ t Date
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