OP RHTE# ~-s 26 143W Harnett County Department of Public Health
PERMIT # ep ration Per 21 7 3 4
2 New Installation Septic Tank C'Nitrification Line El Repair El ExPansior
PROPERTY LOCATION: 3-i-- 4~0'0 J _
Name: (owner) SUBDIVISION LOT # t
Ell
System Installer: -ri~~ __'>i~ Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community LK Public ❑ Well Distance from well feet
System Type: Z~CZ11, / 9~ 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.
IV. Operation:
Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew~ge disposal system on the above captioned property.
Type of system: ❑ Conventional IJ Other Phe A T". w ' 6 4'-SFptic Tank: gallons Pump Tank: gallons
Subsurface No. of exact I ngth _ width of depth of
Drainage Field ditches Z of each ditch l~ C3 feet ditches -3 feet ditches Z7-' inches
French Drain Required: linear feet
Authorized Stat gent Date 5 2G -I
PUMII CUNDIIIUNS:
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.
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