OPHTE -5YZ 5 Harnett County Department of Public Health 23573
PERMIT # —/ Operation Permit
C New Installation C1' Septic Tank E Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:�f�a�
Name: (owner) SUBDIVISION LOT # Y
System Installer: J ry. Registration #
Basement with plumbing: ❑ Garage E< Number of Bedrooms
Type of Water Supply: ❑ Community d Public ❑ Well Distance from well feet
System Type: ZSR U677 !, % G,' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta ealth Department 6 months prior to expiration for permit renewal.
❑us >rxeul lids ueen nlslauea 1n
wlrn appucame north Larmma beneral )tatutes, 8ules for )ewage Ireatment and Disposal, and all conditions of the
I Lill 111 W116i1111,1113.
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:
Permit and Construction Authorization.
Ib
SD
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other U CTZ z - '�� y57t /� Septic Tank: f D° a gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch ?) feet ditches feet ditches Z6>f9
French Drain Required: Linear feet
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Authorized State Agent—, '� / '/, X J�� _ " "` Date
PWR Line
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