OP RHTE# Iz -! - �� Z� Harnett County Department of Public Health
PERMIT # 7-77,26 / Operation Pe 22668
Q/ New Installation E2 Septic Tank Lzl Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION6 i
Name: (owner) S 6 44e SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public Well Distance from well i feet
System Type: , `' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner Aes\fo must co act Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, R ewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System all perform in accordance with Rule .19 .
11. Monitoring: As re ired by Rule .1961.
III. Maintenance: As requ' Rule .1961. Other:
Subsurface system or required? Yes ❑ No ❑
If yes, see attached sheet fora o eration conditions, maintenance and reporting.
IV 0 eration•
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V. Other:
F-1
D -Box El
Pump El Alarm El
11 PWR Line
Following are the specifications for the sews
disposal system on the above captioned property.
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Type of system: ❑
Conventional Other
25 f t Septic Tank: i
gallons Pump Tank: gallons
Subsurface
No. of
5
exact length width of
depth of
Drainage field
ditches
of each ditch feet ditches
feet ditches Z2 e inches
French Drain Required: Linear feet
Authorized State Agen Z MAX4 kxiyj Date
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