OPNTE# 1(��TN6 1
PERMIT # aFI02.O
Name: (owner) ':Y�6
System Installer.
Basement with plumbing: ❑
Type of Water Supply: ❑ Co
System Type:
(In accordance with Table V a)
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Harnett County Department of Public Health 24280
Operation Permit
New Installation N Septic Tank Nitrification Line 11 Repair E:1 Expansion
PROPERTY LOCATION: RoilL6y taonos D
Z.cn / ))vom s SUBDIVISION LOT #
)z"V<""%w\ Registration #
Garage Number of Bedrooms 3
unity Public ❑ Well Distance from well feet
Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiation for permit renewal.
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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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Penna and Construction Authoneatian.
❑ D -Box
❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal s
disposal
stem on the above capti d property.
Type of system: ❑ Conventional
Other
�u Septic Tank: IGOO
gallons Pump Tank: gallons
Subsurface No. of
exact length width of
depth of
Drainage Field i
of each ditch 300 feet ditches }
feet ditches 36- W inches
French Drain Reauired�
® linear
feet
Authorized State Agent "p., 7 v\ t ib Date
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1
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111
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1
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