OPHTE# IC>Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 8 3
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W \L-, Lvc,~s e-D
Name: (owner) )eLL c)mSUBDIVISION G~~wi»c~. LOT # S Z)-
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t®O feet
System Type: 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.
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wlTn appucame norm larouna General matutes, Rmes for sewage Treatment ana Ulsposal, ana an conalllons of the Improvement Permit and lonstructlon Authorization.
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1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches ' of each ditch a'*-~ ® feet
H2OLine ❑
PWR Line
Septic Tank: 1 b QQ gallons Pump Tank: gallons
width of depth of
ditches feet ditches 1 S" as inches
French Drain Required: Linea et
Authorized State Agent Date 1 1 1 0
Alarm ❑
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