OPHTE# OP?- ---ZlCOO Harnett County Department of Public Health
20429
PERMIT # 25 I y (f Operation Fiergt-
I~ New Installation 2" Septic Tank EJ Repair 2 //Nitrification Line O Expansion
PROPERTY LOCATION:,W-
Name: (owner) 5kaa I . ,day,, b rk -r, SUBDIVISION /eve. -LOT # /0
System Installer: Registration #
Basement with plumbing: ❑ Garage ^/Number of Bedrooms 3
Type of Water Supply: ❑ Community FR Public ❑ Well Distance from well feet
System Type: 1s% Sz e rn G `L`'`s"fypes Y and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
IV. Operation:
V. Other.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other _Z5% )0,15y4nv-ii Septic Tank: / 00 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 7~ feet ditches - feet ditches inches
French Drain Required: Linear feet
Authorized State AgenQ'h Z / , ~ A--o V~ Date 3b=bg I
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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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