OPHTE# ! r i Harnett County Department of Public Health
PERMIT # 2 Operation Permit 21 7 2 2
2 '/New Installation LEI Septic Tank ZNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;, j J? ZZ6
Name: (owner) Ad,A.r SUBDIVISION LOT #
System Installer: "r _ _ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms -3
Type of Water Supply: ❑ Community LA9 Public ❑ Well Distance from well feet
System Type: X )&91) ` LIT'6 1-"Z° Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in c
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3-i9°Ii
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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nd all conditions of the
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System shall perform in accordance with Rule .1961. i
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 ❑ H201-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the abo a captioned property.
Type of system: ❑ Conventional Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches 13 inches
French Drain Required: Linear feet
Authorized State ent Date
Permit and Construction Authorization.
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