OPHTE#,)- - ecj7,b` Harnett County Department of Public Health
PERMIT # yam Operation Permit 2 2 0 5 4
L~ New Installation c Tank 2~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: qc~3
Name: (owner) SUBDIVISION LOT # 74I
System Installer: ll~ m Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community El"'Public ❑ Well Distance from well feet
System Type: L161 "r ; .4-r cif 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.
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PERMIT rONnITIOW-
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sews disposal sys em on the above captioned property.
Type of system: El Conventional Other 50A, ~f~ r41 Septic Tank: f a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch f feet ditches 3 feet ditches Y 15'-li es
French Drain Required: Linear feet
Authorized State ent - Date W M~
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11-5-26425 (1) 11-5-26425 (2)
11-5-26425 (3)
11-5-26425 (4)
11-5-26425 (5)
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11-5-26425 (6) 11-5-26425 (7)
11-5-26425 (8)
11-5-26425 (9)
11-5-26425 (10)
11-5-26425 (11)
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11-5-26425 (1) 11-5-26425 (2)