OPHTE#~ f A/ 3T Harnett County Department of Public Health
PERMIT # 3 / Operation Pe mit 21739
V New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION-let-77& ®1~ 1-4it, . i-6 ED
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Name: (owner) J®o ~ _1551Z SUBDIVISION 1 . j, LOT # It
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 6Z Types V and VI stems 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
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
111. 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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the see disposal system on the above captioned proper.
Type of system: ❑ Conventional Other ZA Septic Tank: 1 ac c~ gallons Pump Tank: gallons
Subsurface No. of exact len t width of depth of
Drainage Field ditches of each ditch /04> feet ditches feet ditches Zq 7710 - inches
French Drain Required: Linear feet
Authorized State Ag Date
ell
all conditions of the Improvement Permit and Construction Authorization.