OPHTE# //-,57- v Harnett County Department of Public Health
PERMIT # t` 0 eration Permit 2 2 0 0 3
V "New Installation 2er Septic T nk d Nitrification Lin ❑ Repair ❑ Expansion
/ PROPERTY LOCATION,
Name: (owner) C b~ r Lr ctrl SUBDIVISION s LOT # 'Z
System Installer: 0~7t- j- J- c Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 17
Type of Water Supply: ❑ Community LM1 Public ❑ Well Distance from well f c`= feet
System Type: ~ 61 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.
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No V
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 th
T
f
e specifications for the sews
❑
disposal system on t}ie above captioned property.
EZ H
0
ype o
system:
Conventional O
o vJ
ther
Septic Tank: 0
gallons Pump Tank: gallons
Subsurface
No. of
exact length c~
-
width of depth of
Drainage Field
ditches
of each ditch f
feet
ditches 3 feet ditches o2 inches
French Drain Required: Linear feet X Authorized State Ag en Z:_~ =Z& Date d/1
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