OPHTE#Oe-s - Zozos- Harnett County Department of Public Health 2 0 4 2 8
PERMIT # Z'l / z Operation Pe ltt
New Installation LI✓ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATIOW.,:5,./,/oo ti-, Qo,,~p
Name: (owner)] ,c,t,~ 6,ce9 S,vc SUBDIVISION LOT # L
System Installer„ S. E Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ZS°/a G~UC7t~J~,,a{r 2 mJ7 6 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ownc~c uaaifh nona.rmo~f 6 months prior to expiration for permit renewal.
IV. Operation:
V. Other.
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other a 5% "u&r7tA) Septic Tank: 12200 gallons Pump Tank: ! a U O gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches - of each ditch 140 Q feet ditches 3 feet ditches I inches
French Drain Required: Linear feet
Authorized State Ag r, - G / I I A,,Ayj-,l 2"' Date I -2 (0
rtKMI I IUNUII IUN):
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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.
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