OPHTE# (�- 6 - MJX Harnett County Department of Public Health 24642
PERMIT # 2ef"� '4 eration Permi
0" New Installation eptic Tank 11- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -3-10 yc —&,ttaA 6td .ret'Vtiq)
Name: (owner)- 5 wtc;l Y (1s S,c- SUBDIVISION /-/G Aden Co;A4e LOT # Y/
System Installer. 6&')U I a C, Registration #
Basement with plumbing: ❑ GarageN Is r of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
Ines system has been Installed in comphabte with appllable north tarohna beneml Statutes, Rules for lewage Irealment and Disposal, and all conditions of the Improvement Peanut and Loirmualon Aulhanaation.
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reernl wnuluurea:
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 sewaa osal system on the above captioned property.
Type of system: El Conventional Other 4Q G/O� Septic Tank: A e --P3?.) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch k feet ditches feet ditches ZZ— inches
French Drain Required: Linear Feet
Authorized State Agent "%- —r�� �il�✓ `�, P Date " Z 2
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