OPHTE#is -7s-�� Harnett County Department of Public Health 23951
PERMIT # z9 Operation Permlt
New Installation r Septic Tank PT" Nitrification Line ❑ Repair ❑ Expansion
I PROPERTY LOCATION: oZ3 9 l wr'o of Rd
Name: (owner) Sr 1eI SUBDIVISION LOT # Q 33
System Installer: o --+;r Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms —
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: Types V 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.
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Wr Other E2 -Floc.) Septic Tank % UUO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch aa,i— feet ditches 3 feet ditches 3U -c20 inches
French Drain Required: Linear feet
Authorized State Age e Date
- -3
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