OPHTE# If -S 'Z J_Z8 Harnett County Department of Public Health
PERMIT # ,(Q 65-7 Operation Permit / 2 2 0 3 7
Rl New Installation 0 Se tic Tank M Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: r,~, ~i4f Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 21 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.
tms system nas peen instaheo in compliance with applicable North larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other:
❑
D-Box
Following are th
e specifications for the
Type of system:
❑ Conventional
Subsurface
No. of
Drainage field
ditches
❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sew ge disposal system on ,thf a-bo/ a capti ned property.
Other u = ~-k `z tts-,- ze,- Septic Tank: /000 gallons Pump Tank: gallons
exact length width of depth of
C of each ditch o4 I feet ditches feet ditches °2 inches
French Drain Required: Linear feet
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Authorized State Agent Date
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