OPHTE#//-o°-- 81 q Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 4 4
New Installation k;I Septic Tank Q-'`Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: } f w
Name: (owner) r SUBDIVISION & LOT # ~7 L
System Installer: 7°~d . Zti Registration #
Basement with plumbing: ❑ Garage Cl'` umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: `s 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.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewa disposal system the above captioned property.
Type of system: ❑ Conventional EY' Other - 26
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
H2OLine ❑
Septic Tank: / v gallons Pump Tank:
width of depth of
ditches feet ditches / C '
PWR Line
gallons
inches
French Drain Required: Linear feet
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Authorized State Agen •m, 1~~ Date 'dot/
Alarm ❑
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