OP RHTE# D 6 SD - IS /~5v2 Harnett County Department of Public Health
PERMIT # 3 s~ Operation Permit 21 6 5 5
DLtNew InstallationC~Z Septic Tank. Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \ `A
Name: (owner) SUBDIVISION r!'~k"I l~> LOT # 2
System Installer: ) (2,-c K ~ o., A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3_
Type of Water Suppl : ❑ Community J41 Public ❑ Well Distance from well \ feet
System Type: ' F \ o--, j 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.
pmm nas oeen ins[anea in compliance with applic
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PERMIT CONDITIONS:
North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No -1K
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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 9~"j Septic Tank: gallons Pump sank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch O J feet ditches 3_ feet ditches c?` r
inches
French Drain Required: _ linear feet
Authorized State Agent ~ L&I UZ Date '
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