OPHTE# 0~ Harnett County Department of Public Health 2 0 6 5 4
PERMIT # c~a2- 0 eration Permit
New Installation PI-s-e ptic Tank ❑ Repair 'Nitrification Line ❑ Expansion
PROPERTY LOCATION: 2
Name: (owner) SUBDIVISION 2c n 0 r~- LOT # 3
System Installer z V ~ A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supp : ❑ Community 5Z1_ Public WWII Distance from well ~J _ feet
System Type: `2• 2 F C> ) V - 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.
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wim appluaoie north larolma funeral Statutes, Rules for Sewage Treatment and
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DCDMIT rA11AITIAIIt.
and all conditions of the Impro!tmt
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Permit and Construction Authorization.
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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
Following are the specifications for the sewage disposal system the above captioned property.
Type of system: El Conventional Other 2 C I ~~V Septic Tank: gallons Pump Tank: gallons
Subsurface No. of t5 exact length width of depth of
Drainage Field ditches of each ditch feet ditches _ 3 feet ditches ~ 'A'- inrhpc
rent rain Required: Linear feet
Authorized State Agent s Date o S"
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