OP R1171#07 - - Harnett County Department of Public Health 1 g 8 2 4
PERMIT # 1 I Okeration Permit
New Installation - td Septic Tank ❑ Repair l1' Nitrification Line ❑ Expansion
PROPERTY LOCATION:- r
Name: (owner) SUBDIVISION LOT # .7
System Installer 1?0 ~.a f Registration #
Basement with plumbing. ❑ Garage ~ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: C , J = c.;z- Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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PERMIT cONMONV r-
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
Y. Other.
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 ❑
H yes, see attached sheet for additional operadon conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional C Other ]°/,i2E~l)C{ Size of tank: Septic Tank: /U y o gallons Pump Tank: gales
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 1 LO feet ditches- feet ditches finches
French Drain Required: linear feet
Authorized State Agent.
Date / U "7
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