OP RHTE#_/0- -Z3 iZ Harnett County Department of Public Health
PERMIT # ~j z 0 eration Peit 21 71 3
ENew Installation 1 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rg3y fiq-t ~ eZp
Name: (owner) DID l~t✓ ~ OzJl ~ SUBDIVISION LOT # ~
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1-!~f tie & 62-r- 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 r newal.
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 Constiction Authorization.
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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
100 14- -°j
lb
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
r4
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and
ng.
V. Other:
❑ D-Box ❑ Pump ❑ Al lm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned proper.
Type of system: El Convent
ional Other d%~-
L4 Septic Tank: 1 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch CZ> feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age~it
AL
Date
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