OPHTE#_Z s" ail /Z Harnett County Department of Public Health
PERMIT # a~- 0 ,era" ~Peerrmit 21 5S9
EI'New Installation Lrl Septic Tank 2"Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATIO
Name: (owner) SUBDIVISION 1r
System Installer.{ ( a ld LOT # /Si
Registration #
Basement with plumbing ❑ Garage "Number of Bedrooms
Type of Water Supply: ❑ Communik~ublic ❑ Well Distance from well
System Type: feet
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.
This 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:
I. Performance:
II. Monitoring:
III. 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
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❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewspllsposal stem on the above captioned property.
Type of system: ❑ Conventional 2' Other L: Z 7c(- cry
Subsurface No. of Septic Tank: /(X°'Q gallons Pump sank: gallons
exact length width of depth of
Drainage field ditches of each ditch 7 feet ditches
French Drain Required: feet ditches d inches
Linear feet
Authorized State Agen ezx Date 111/1x4C10
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