OPHTE#j i -t Harnett County Department of Public Health
PERMIT 0 eration Permit 21 9 7 5
\ New Installation ° Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ooc :s VKD
Name: (owner) `)N CNDCI-X) ~~o to SUBDIVISION ~2rcrrC~~zs IiZavo6E, LOT #
System Installer: 1%-Noq.--, oNs 9I-urn NG Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 'R Public ❑ Well Distance from well l~ ® 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.
ims system nas peen instauea in compuance wim appucanie norm Larouna beneral )tatutes, Rules for )ewage Ireatment and
and all conditions of the
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Permit and Construction Authorization.
rtKMIl LUNUIIlUNY
1. Performance:
11. 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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the spec
ifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other E°Z--~t,dw Septic Tank: 100
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches
\ of each ditch S-G feet ditches
feet ditches a inches
French Drain Reauired:
- .
Linea eet
Authorized State Agent -.N,\ Date 6N 1
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