OPHTE# JO _s=z~y Harnett County Department of Public Health
PERMIT # Operation Perm 't 21 5 5 8
2" New Installation L Septic Tank IS? Nitrification Line ❑ Repair ❑
Expansion
PROPERTY LOCATION.
Name: (owner) rcd / Qc SUBDIVISION c F~~ 164-
LOT #
System Installer: _ .,~e x,14 Registration #
Basement with plumbing: ❑ Garage VNumber of Bedrooms -
Type of Water Supply: ❑ Community LEI Public ❑ Well Distance from well feet
System Type: 7il 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.
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: '
L Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. 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 ❑
Pum
❑
l
p
A
arm ❑ H201-ine ❑
PWR Line
following are the spec
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e
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t
❑
ifications for the sew
disposal system on he above captioned property.
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sys
em:
Conventional O
ther F 2- ~
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Septic Tank: 100c,
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P
Subsurface
N
ga
ons
ump Tank: allons
g
Drainage Field
o. of
ditches
exact length
of each ditch ~'sy feet
width of
depth of
ditches J f
French Drain Required:
Linear feet
eet ditches inches
Authorized State Agen..f Date
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