OPHTE# 11-5-144094 Harnett County Department of Public Health 25086
PERMIT # 301 Operation Permit
New Installation Septic Tank )�( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: O v s q QP
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Name: (owner) 0"M cs Guy SUBDIVISION LOT #
System Installer. 8o46tby ^1 i-wr^i Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community eeg Public ❑ Well Distance from well feet
System Type: 1 1R 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.
[his system has been installed in compliance with applicable North Camlina General Stens, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conswttion Authorization.
a
Ir
PERMIT CONDITIONS
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 cc
IV. Operation:
Other.
maintenance and reporting.
❑
—D -Box 1-1Pump
❑
Alarm L]H2OLine ElPWR Line
Following are the
specifications for the sewage disposal
system on the above tioned property.
Type of system:
❑ Conventional Other &%mG&cz_
'C04
Septic Tank: L t_,n D gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch aco feet
ditches 3 feet ditches R inches
French Drain Required: Linear feet
Authorized State Agent Rpt Date
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