OPHTE# o 7-~ 13 arz Harnett County Department of Public Health 21282
PERMIT # 4 eratio-n P-eer.~-iitt
New Installation Septic Tank ❑ Repair Nitrification line ❑ Ex
panslon
PROPERTY LOCATION:
Name: (owner) wt c ^'*\0,'f SUBDIVISION
System Installer. & `1`~ n LOT #
Registration #
Basement with plumbing: ❑ Garage 0' Number of Bedrooms 7
Type of Water Supply: ❑ Community "Public ❑ Well Distance from well
System Type: ~ feet
(In accordance with Table V a) Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes Rules for Sewage Treatment and Di I conditions of the Improvement Permit and Construction Authorization.
m
PERMIT CONDITIONS:
L Performance:
IL Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other
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It
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
following are the specifications for the sewa disposal system on t e ove captioned property.
Type of system: ❑ Conventional Other i ~ n .,C Subsurface No. of Septic sank: gallons Pump Tank: gallons
Drainage ~ exact length width of Field ditches of each ditch depth of
French Drain Required: Linear feet - feet ditches feet ditches c26 inches
Authorized State Ag C~V Date d
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