OPHTE# f.5 -t�' -30 ? Harnett County Department of Public Health 23176
PERMIT # 2- 73C,aS Operation Permit
®' New Installation 2" Septic Tank 2rr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION5cz5 ?1
Name: (owner) „-.: SUBDIVISION 5;% LOT #
System Installer: " ° Registration #
Basement with plumbing: ❑ Garage Gd Number of —Be�,d,�°oms
Type of Water Supply: El Community Public Dwell Distance from well / feet
System Type: C(c V- 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 LI \1111 I.VI\VIIIVI \J.
1. Performance: System 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: 9 Conventional D Other
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch f -. a' 3 feet
Alarm ❑
H2OLine ❑
Septic Tank: gallons Pump Tank:
width of depth of
ditches feet ditches _
French Drain Required: Linear feet
,.. f�
Authorized State Agent Date
PWR Line
gallons
2�e ? i ?, inches
13 -5 -30897 (1)
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13 -5 -30897 (11) 13 -5 -30897 (12)
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