OPHTE# Harnett County Department of Public Health
PERMIT # ~ -257 Operation Permit 21 71 9
❑ New Installation ❑ Septic Tank ® Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,a c./72-
Name: (owner) -1 SUBDIVISION Dm),j~~
- r LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Be orns
Type of Water Supply: ❑ Community ❑ Public L Well Distance from well ite,> feet
System Type: L'5% tZ,®i3i PU7r~ > ~ c, a 4-±7 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.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property &
Type of system: ❑ Conventional Other o (<";.rf 1,76Q LA) Septic Tank: 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Li of each ditch 15-_ feet ditches feet ditches -2 inches
French Drain Required: Linear feet
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