OP RHTE# 07 ---,7-- 7/~ Harnett County Department of Public Health 20919
PERMIT # Z yy35 0 eration PeI-t
WNew Installation L~1 Septic Tank ❑ Repair Nitrification Line ❑ Exnancinn
PROPERTY LOCATION:.
Name: (owner) SUBDIVISION, LOT #
System Installer ij- Registration #
Basement with plumbing: ❑ Garage Rf. Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: G 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.
3rac11i nay ueen imiaiea in compuance wtte apphcabie North Carolina General Statutes, Rules for Sewage Treatment and
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PERMIT CONDITIONS:
and all conditions of the Improvement Permit and Construction Authorization.
I. 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other ZS"/a i2C-p& ~ Septic Tank: jo n 6 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches L- of each ditch feet ditches 3 feet ditches ;n - inches
French Drain Required: Linear feet
Authorized State Agen/ /q Date -
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