OPa.9t 18
HTE# Harnett County Department of Public Health
PERMIT # a t y Operation Permit 22393
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J New Installation 12"Septic Tank 2'�Nitrifcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Wc- 2) �t
Name: (owner) v.4 L _�tis�, _ SUBDIVISION LJ< LOT # '24
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms _
Type of Water Supply: ❑ Community C- Public ❑ Well Distance from well feet
System Type: -1:;T—G— 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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I. 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.
tat
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o-
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sews p
disposal system on he above captioned property.
Type of system:
J
6 Z `lam Septic Tank: /000
gallons Pump Tank: gallons
rcnrut t.vnuutvnx
I. 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 ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sews p
disposal system on he above captioned property.
Type of system:
El Conventional Other
6 Z `lam Septic Tank: /000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches J
of each ditch 7 feet ditches 3
feet ditches inches
French Drain Required: Linear feet
Authorized State Agent =/z/ Date l `7 /aid
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