OPHTE#rr .r-Z. S Harnett County Department of Public Health
PERMIT # O%Z 1 Operation Peymit 21 7 4 3
171 New Installation LJ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /5-5-Z - , 14
Name: (owner) SUBDIVISION LOT #
System Installer: 165M Registration #
Basement with plumbing: ❑ Garage Z' Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public Id Well Distance from well 6S feet
System Type: Z~% g6vau-1- it 1 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:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 7. tiCr Septic Tank: gallons Pump Tank: 4a gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Z inches
French Drain Required: Linear feet
Authorized State Ag rz~~~Z' 4'?,- Date (0-)l
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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.
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