OP RHTE# i - -5 i g51� Harnett County Department of Public Health 23205
PERMIT # 'Z:7 '-2 't-5— Operation Per, - it
2 New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:* -1105 O/�1�ia,3= ' iS"W V--b
Name: (owner) -- SUBDIVISION s LOT # IS
System Installer: 1`LCl Registration #
Basement with plumbing: ❑ Garage Z"qW&er ofiedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: R e r -?' 3. Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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:
Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: El Conventional Other t*y—,60 L4104 __ Septic Tank: /000 gallons Pump Tank: t gallons
Subsurface No. of exact length width of _ depth of
Drainage Field ditches of each ditch feet ditches feet ditches s6 inches
French Drain Required: Linear feet
Authorized State Age Date "7 ' — / Ll
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