OPHTE# /0----2 c/ /,.3Z Harnett County Department of Public Health
PERMIT # a k- c-' f ci Operation ~P.errmii-t 21 5 3 8
P'New Installation E Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 22-? ~-,3 -s-~"
Name: (owner) ~ 4st SUBDIVISION 7%',435--, R=-'Lt LOT # /-7
System Installer 'IC114y 31-t f -111 Registration #
Basement with plumbing: ❑ Garage CKNumber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 7L 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.
ims 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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PERMIT CONDITIONS: ors Qom. c
1. Yertormance:
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
A- 2s E
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D-Box
Pump Alarm
C~1 H2OLine
C~ PWR Line
Following are the specifications for the sewsgvdisposal system on the Above phone prope
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ype o
system:
❑ Conventional
C Other -
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Septic Tank: gallons
Pump Tank: /(30
gallons
Subsurface
No. of
exact length
width of
depth of
Drainage field
ditches
of each ditch /,G feet
ditches feet
ditches inches
french Drain Required: Linear ft
Authorized State Agent - i~~ Date a
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