OPNTE# f�3- 6 -u 33cy4 Harnett County Department of Public Health 24159
PERMIT # t:rE rc. V_ Operation Permit �-
❑ New Installation El Septic Tank 2' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (.9 � ���"� na . (ctols As (LA. sz tN s�
Name: (owner) SUBDIVISION LOT # t `t
System Installer: _-e� Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms V --
Type of Water Supply: ❑ Community Coi- 1oblic ❑ Well Distance from well '�A feet
System Type: 2 s Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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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.
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❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewage sal
system on the above captioned property.
Type of system:
❑ Conventional Other
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Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 3
of each ditch feet
ditches 3 feet ditches 'c-1 inches
French Drain Required: Linear feet
Authorized State Agent 0 �—� - Date a c'
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