OPHTE# /0 S- ~~C,8t Harnett County Department of Public Health
PERMIT # Neration Permit 21555
D--"New Installation 14°'Septic Tank Nitrification Line 0 Repair O Expansion
( PROPERTY LOCATION: lea.
Name: (owner) SUBDIVISION lie.. r.~1 LOT #
System Installer. C,t+ f S-f,-= Registration #
Basement with plumbing. ❑ Garage umber of Bedrooms _ _7
Type of Water Supply: ❑ Community Id Public ❑ Well Distance from well feet
System Type: C, 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.
Ihis 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.
Ill. 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 ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage dispos
al jystem on he above captioned property.
1
Type of system:
El Conventional 91 Other
,1wt
L Z. ,C
Septic Tank: OOQ gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length
f
h di
h / 80
width of depth of
3
o
eac
tc
feet
ditches 1
feet ditches inrhec
rent ram equlre : Linear feet
Authorized State Agent Date /c'%~/~ c~
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