OPHTE #Js -5 - 7 Harnett County Department of Public Health 23776
PERMIT # ? f;7. Operation Pe et
IJ New Installation Ic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION• ,G/
Name: (owner) �',�, v' �- r'�.� �,�,,ul SUBDIVISION LOT # z
System Installer: - ' _.� / Registration #
Basement with plumbing: ❑ arage O umber of Bedrooms _5
Type of Water Supply: ❑ Community Lei Public ❑ Well Distance from well feet
System Type:-5;�, gam_ % y rte! 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.
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PERMIT CONDITIONS:
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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sa disposal system on the above captioned property.
Type of system: El Convent
Conventional Other IZQQC '-rn ) Septic Tank: / Oy Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch feet ditches feet ditches A-1 S? inches
French Drain Required: _ Linear feet
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Authorized State Aen�'%-�— u-= . � � � �%_ Date
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