OPHTE#/-~" Harnett County Department of Public Health
PERMIT # (9/ Operation Per it 2 2 3 7 0
C0" New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION:
Name: (owner) r't Cs-A ~P r) SUBDIVISION LOT #
System Installer: A,r-4 fir` ° nS J'e'Registration #
Basement with plumbing: El Garage 121"Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: b 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.
Ihts system has been installed in
with applicable north t.aronna uenerai statutes, lutes for sewage treatment and msposat, ana an conatnons m me improvement rermt ana construaton numonzauon.
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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule A61.
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 ❑ Pump ❑
Following are the rconventional cations for the sewage disposal system on the above captioned property.
Type of system: ❑ Other
Subsurface No. of exact length
Drainage Field ditches y of each ditch 00 feet
Alarm ❑
H2OLine ❑
Septic Tank: 1000 gallons Pump Tank:
width of depth of
ditches 3 feet ditches /
PWR Line
gallons
inches
French Drain Required: Linear feet
Authorized State Agen Date 7Ll-~Z-4(71X
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