OPHTE# /.3- =3d1�� Harnett County Department of Public Health
PERMIT # 9--? `/z2- Operation Per it 22934
ICI New Installation Se tic Tank R / Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO :
Name: (owner) 2.`// do./4 `L sf SUBDIVISION LOT # 71
System Installer: ,T titer r, ' c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Pf Public ❑ Well Distance from well feet
System Type: 77%- 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, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance:
II. 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.
French Drain Required: Linear feet
Authorized State Age Date 7 //0 /� °��
D -Box ❑
Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the se�wa disposals stem on the /above captioned property.
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Type of system:
❑ Conventional I.fd Other
F - V < Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch ate_ feet ditches /
feet ditches 0-06' inches
French Drain Required: Linear feet
Authorized State Age Date 7 //0 /� °��
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