OPHTE # - =% Harnett County Department of Public Health
PERMIT # Permit 22914
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION ( - -R''� l� C'� LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 'IE� Number of Bedrooms
Type of Water Supply: ❑ Community ',E� Public ❑ Well Distance from well \ U O feet
System Type: 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.
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No�
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the abov capti d property.
Type of system: ❑ Conventional Other t, KAEC2— L �U"J Septic Tank: i® ® gallons Pump Tank: gallons
Subsurface -- —_ N__ _o of exact length width of depth of
Drainage Field ditches ' of each ditch M0 feet ditches feet ditches inches
French Drain Requir.� z�c -LUG i� cNos�
Authorized State Agent ` � �����.,� Date A V
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