OPHTE# X-.3- ~"-gg?0 Harnett County Department of Public Health
PERMIT # oZ~ tZ Operation Permit 21 8 0 8
'Ne'w Installation 2" '-Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /Ill. 0 ev - Q: 4~ I,
Name: (owner) SUBDIVISION ').3 £ ~ LOT #
System Installer: /11 lr E.4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Z
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: G- 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 6111111 LVI\V111VI\J.
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:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
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 O
ther i , ; r C ;.nt
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches C
of each ditch /00 feet
ditches feet ditches / ' inches
French Drain Required: Linear feet
Authorized State Agen ra Date -2.f "-of(
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