OPNTE# -5 4 94 Harnett County Department of Public Health 24973
PERMIT# 94G+ eration Perm' �/�
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1511 mM `vor, rLA . SZ if,,
Name: (owner) T -0m<%14 A\\P—n SUBDIVISION LSV tic e\d LOT # ,3
System Installer. jcnnv'. Registration #
Basement with plumbing: ❑ Garage � Vu�3
rof Bedrooms
Type of Water Supply: ❑ Community IiPublic ❑ Well Distance from well Nk feet
System Type: `, C!®.\�L-J.-. i 5,sl-:vl Types V and YI Systems expire in 5 years.
(In accordance with Table V a) VOwner contact Health Department 6 months prior to expiration for permit renewal.
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PLNMII IUNDIIIUNS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the sewage dis em on the above captioned property.
Type of system:
❑ Conventionalcher
C- Z ILA � -. ct�
Septic Tank: gallons
Pump Tank gallons
Subsurface
Drainage Field
No. ofexact
11{
ditches T
length
of each ditch (i C) feet
width of
ditches _ feet
depth of
ditches /25 inches
French Drain Required: Linear feet /
Authorized State Agent Date 06 103 ! ao
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