OPHTE# -79-!5 - AW7 Harnett County Department of Public Health
PERMIT # Z-37z:7 / Operation Permit 2 2 2 6 8
C" New Installation Septic Tank l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Name: (owner) SUBDIVISION LOT # %z-
System Installer:. Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community L~f Public ❑ Well Distance from well feet
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v < hype Systems expire in 5 years.
System Type:
- 'land VI
(In accordance with Table V a) Ow r must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas Deen mstauea in compliance wan
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
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Following are the specifications for the sewage disposal system oii `the above cap coned proper
Type of system: El Conventional Other Z501o ,Z'v1~ C Z Tank: 1 C 6 gallons Pump Tank: f 100 gallons
Subsurface No. of 9 exact length width of depth of
Drainage Field ditches ~t of each ditch feet ditches feet ditches Zinches
French Drain Required: Linear feet
Authorized State Ag t Date
norm Carolina uenerai statutes, nutes for sewage treatment ana
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07-5-16827 (1) 07-5-16827 (2)
07-5-16827 (3)
07-5-16827 (4)
07-5-16827 (5)
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07-5-16827 (6) 07-5-16827 (7)
07-5-16827 (8)
07-5-16827 (9)
07-5-16827 (10)
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07-5-16827 (11) 07-5-16827 (12) 07-5-16827 (13)