OP RHTE# 10 = RYaa3X Harnett County Department of Public Health
PERMIT # ,R y0 Operation Pert ~ 21 5 2 8
l 0 /"New Installation R/ Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
C woe, ~ ✓ PROPERTY LOCATION- ~I c -,,--k , -
Name:
(owner) ~ S` SUBDIVISION LOT # S"
System Installer. o ~dv ~~.-l{ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: 1L b 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 installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. 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:
7 ~ a C /f3
V. Other.
l W K5 - U" -
❑
D-Box ❑ Pump ❑ Alerm
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H20Line PWR Line
Following are the specifications for the sewa dispos system on the above captione propel}'.
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Type of system: ❑
- c~.~. y tr
Conventional Other r" - -
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Septic Tank:
gallons Pump Tank: gallons
Subsurface
Draina
e Field
No. of exact length
3 0 0
dit
h
width of
depth of
`
g
c
es of each ditch
feet
ditches
feet ditches
inches
French Drain Required:
- linear feet
Authorized State Agen Date -V'
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-z-y 2 (3 31L
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