OPHTt# Harnett County Department of Public Health
PERMIT # Operation Permit 21 6 5 3
New Installation~Septic T*c~,Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) CJ ,rv---v Z a 1 SUBDIVISION LOT #
System Installer: L- . S Y\ a., c- Registration #
Basement with plumbing. ❑ Garaged Number of Bedrooms
Type of Wate_r~S.u,Pply: ❑ Community Public ❑ Well Distance from well I-"-3 feet
System Type: ! R c C 1 S ~ 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.
quenj 11d3 Veen noianea in compnance wim applicable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PFRNIT rnNnlTinNc-
t Permit and Construction Authorization
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1. Performance:
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:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑
Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the spec
ifications for the sewage disposals
m on the above captioned property.
Type of system: ❑
Conventional ] Other
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Septic Tank: ~0 gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of ^
y
ditches _ c
exact length
of each ditch feet
width of depth of
ditches feet dit
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French Drain Required:
linear
feet
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Authorized State Agent ~ - W ~A Date - , 3 ' A
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