OP RHTE# -/j-,S 2(_-)A61e Harnett County Department of Public Health
PERMIT Operation Pe It 21 7 2 5
ENew Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:~~J! K1 ,7U
Name: (owner) _z~s PM SUBDIVISION Si-43 LOT # 5
System Installer: ~ xi5mc -t Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ❑ Community r public ❑ Well Distance from well feet
System Type: S rf► Zu G E2-id- 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.
ims system nas oeen mstanea in compliance wo appncame nortn s.arouna uenerai statutes, Hies for sewage treatment ana
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ana an conaitions of the Improvement rermit ana lonstructlon AUtnorizatlon.
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rONniTIM-
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the spe
cifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional Other
Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches .3
of each ditch V feet
ditches 5 feet ditches inches
French Drain Required: Linear feet
Authorized State Age t Date- Z- la
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