OPHTE#07 --S--/7RD Harnett County Department of Public Health 19838
PERMIT # U3 6:2 --~10Deratl0n n feF~
New Installation 2 Se tic Tank El Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:.-se/gg7 lln,,oL C/v4 /t--3
Name: (owner) SUBDIVISION 1n1+c,-.v&4 LOT # Z 3
System Installer. - - Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Ca"'Public ❑ Well Distance from well feet
System Type: Z-M R 60 610 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.
ims system nos Deco MUM in compxance wsm *MUM Ram Whna WlWai VaMes, RDks to sewage Treatment and
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1. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other ZS%t7OGT~N Size of tank: Septic Tank: / 00 y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _ 6 feet ditches 3 feet ditches Z 6" inches
French Drain Required: Linear feet
Authorized State Ag Date