OPHTE# 0-5 =z55 Harnett County Department of Public Health
PERMIT # Z[&D 70 Operation Permit 21 7 3 6
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: fef,t~~
Name: (owner) r1 SUBDIVISION LOT # 34
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
tt-
Type of Water Supply: ❑ Community I~Q Public ❑ Well Distance from well feet
System Type: " _rt cw G- r Types V and VI Systems expire in 5 years.
(In accordance with Table V a) I if Owner must contact Health Department 6 months prior to expiration for permit renewal.
Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: Sy em 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 ❑ ~s_
If yes, see attached sheet for additional operation conditions, mamtenance and reporting.
IV. Operation:
V. Other:
N
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property Cgr
Type of system: ❑ Conventional Lew+~ Other 77i eptic Tank: f Z4~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch bo feet ditches 3 feet ditches 115 inches
French Drain Required: y Linear feet
Authorized State Age t C Date "
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