OPHTE # Harnett County Department of Public Health 2 3 1 8 2
PERMIT # Z, -7 5_2 � Operation Per .t
L'f New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: i
Name: (owner) ° m 1 SUBDIVISION LOT #
System Installer: -r Cam, Registration #
Basement with plumbing: ❑ Gara e 2f umber of Bedrooms
Type of Water Supply: El Community Vpublic ❑ Well Distance from well feet
System Type: ° ., 5 �`'2-- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must co alth Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. 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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other 7u16-IN2 ( Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Z4 °'� t00 inches
French Drain Required: Linear feet
Authorized State A Date
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