OPHTE#y0 ,a 7.5 !5- Harnett County Department of Public Health
PERMIT # '7%7]Z4 Operation Pe it 2 2 0 6
I'I New Installation 9 Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Jk jg-s'3
Name: (owner) ~s 41 +~1' SUBDIVISION 6~ / LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage - (Number of Be ooms
Type of Water Supply: ❑ Community C~ Public Well Distance from well feet
System Type: Zi G- 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, all con ' he Improvement Permitand Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. 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 ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are th
e specifications for the sewn a dispo
sal system on the above captioned property.
Type of system:
❑ Conventional Other
Septj Tank: ot> gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches -Z
of each ditch ` feet
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age t Zq- Date
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6 i
10-5-2360
5 (1) 10-5-23605 (2) 10-5-23605 (3)
10-5-23605 (4)