OPHTE# 7 -J-- / e 75-~- Harnett County Department of Public Health 19664
PERMIT # ,?.q ( 3K O eratlon Permit
L9 New Installation 0? Septic Tank ❑ Repair 2/"Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ~Yn U ,.ld.~f SUBDIVISION (d LOT # qC
System Installer Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: -oaB 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.
This system has been instAd in compliance with aoicabte North Carolina General Satutes, Ruks for Sewage Treatment and Disposal, and A condition of the hnpro"ent Permit and Consmction Authofta iom
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1. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewsKdispos system on the above captioned property.
Type of system: El Conventional M Other t 2 F(~; Size of tank: Septic Tank: gallons Pump Tank: 01 C gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch / ~c" feet ditches feet ditches :2 t ~t inches
French Drain Required: linear feet
Authorized State Agent f. . Date 1 2 y ce~