OPHTE# I3 s -7d, Harnett County Department of Public Health 23931
PERMIT # ai 80) Operation Per It/Neww installation
Septic Tank Nitrification Line ❑ Repair ❑ Expansiod
PROPERTY LOICATION: Z't
Name: (owner)An Co.tr n c : ur SUBDIVISION %ic%i arr.f: t!a e LOT # S" 7
System Installer: A craQZ %,,, kb Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: = b Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Thu system has been installed in compliance with applicable North Carolina General Sta steS Rules for Sewage Treatment and disposal, and all conditions of the Improvement Permit and Lonsuru<uon Authorization
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
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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.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewj6if disposystem on the above captioned property.
Type of system: ElConventional A Other un; CZF�ow Septic Tank: gallons Pump Tank: /OOQ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc 3of each ditch 70 feet ditches _ feet ditches !by• Z5( inches
French Drain Required: Linear feet
Authorized State Agent `1`1� ����� >S Date .I-131) G
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