OPHTE# /f-5 -a-:1q'?4 Harnett County Department of Public Health
PERMIT # Iq Operation Permit 2 2 0 4 0
New Installation IJ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
p PROPERTY LOCATION:
Name: (owner) Tt~ N.ar p~~ @1 SUBDIVISION % i ~~~~rPCr LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: ZEE 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, and all conditions of the Improvement Permit and Construction Authorization
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DGRMIT rnMn1T1n1A9 t G r~C~ t~
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
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 the spe
cifications for the sew a disposal system on t 4e above captioned property.
Type of system: ❑
Conventional
Other 1 r G C;pJ Septic Tank: /a0U
gallons Pump Tank: gallons
Subsurface
No. of ~ l
exact length i width of
depth of
20
Drainage Field
ditches 7
of each ditch1 feet ditches 5
feet ditches 0
inches
French Drain Required: Linear feet p /
Authorized State Agen Date
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