OPHTE# Zo-; - 93 G~z Harnett County Department of Public Health
PERMIT # Operation Per it 21 8 0 4
I New Installation C~3' Se tic Tank i Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~~i,2r,- 'I"
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Y Number of Bedrooms J-
Type of Water Supply: ❑ Community IZ~Public ❑ Well Distance from well feet
System Type: Ga,r~tc. 4"Akce- 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.
mis 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:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Pump ❑ Alarm ❑ H20Line ❑
PWR Line
Following are the specifications for the sewa a disposal system on he above captioned property.
Type of system: El Conventional Other Ck-nS Se tic Tank: 144
Subsurface No. of p gallons Pump Tank: gallons
exact length width of depth of
Drainage Field ditches of each ditch feet ditches J feet ditches
inches
French Drain Required: Linear feet
Authorized State Agen + Date A ✓~a~a
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