OP RHTE# O -S ~Z Harnett County Department of Public Health 2 0 9 0 4
PERMIT # Z" I 2-. /New 0 eration Pe It
Installation E~f Septic Tank ❑ Repair Nitrification Line ❑ Fxnansinn
PROPERTY LOCATION:
Name: (owner) SUBDIVISION r7v, 4ked LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage /Nm er of Bedrooms . (
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: 7 '5' 1, U 6!72
Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must cont ct Health Department 6 months prior to expiration for permit renewal.
ims system nas peen installed in compliance with applicable North
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Rules for
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Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewaedisposal system on the above rapt ned property.
Type of system: ❑ Conventional L~ Other Z S~"/o a "-w r Septic Tank: Z& D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch /06 feet ditches _3 feet ditches cinches
French Drain Required: Linear feet
and all conditions of the Improvement Permit and Construction Authorization.
L Authorized State ent ~i.~r~~~ Date
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