OPHTE# 0Harnett County Department of Public Health 21 0 8 4
PERMIT # Opefatl0n Perftltt
New Installation Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: M PQ-,4,5 (2,c,
Name: (owner) \-AK, - SUBDIVISION AtA~,,6Fc%. p
System Installer: 7Eo $~errrht LOT
Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms - 3.-_
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well Vb d
System Type: o.~ feet
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 hafn in,tA-A i„ --d;--
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
V. Other.
Permit and Construction Authorization.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other _QvNc.\` 4 Septic Tank: V d0d
Subsurface No. of exact length gallons Pump Tank: gallons Drainage field ditches Q- of each ditch G
feet width of depth of
ditches feet ditches inches
french Drain Required: linear feet
Authorized State Agent
Date V01
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)<
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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