OPHTE# jZ-5-- zee Harnett County Department of Public Health
PERMIT # 2J-081S Operation Pemlit 22259
Ed New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 6;L
Name: (owner) NZC
41-
SUBDIVISION CMG LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedroom sX7
Type of Water Supply: ❑ Community Y Public ❑ Well Distance from well feet
System Type: 2 SY,5 T~ , c.. ~M 6 ' 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.
I LM 111 W11UMVI13.
1. 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 ❑ H201-ine ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Other ,-v Septic Tank: i4ob gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch t e>0 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State nt Date 3 -/'L
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12-5-28209 (2) 12-5-28209 (3)
12-5-28209 (4)
12-5-28209 (5)
12-5-28209 (6)
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12-5-28209 (1)
12-5-28209 (2)
12-5-28209 (3)
12-5-28209 (4)
12-5-28209 (5)