OPHTE# - 4 - Harnett County Department of Public Health
PERMIT w Operation Plerit 2 2 0 5 9
2 /New Installation 2 "'Septic Tank D'/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:, >
Name: (owner) qza SUBDIVISION LOT #
System Installer: c w.,4 C ) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: e 751k, 217' 6~- 4KIII . L 4 p qV and VI Systems expire in 5 years.
(In accordance with Table V a) Ow er must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
rertormance: System snail pertorm in accordance with Itule .1961
Monitoring: As required by Rule .1961.
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property. ~~L
Type of system: ❑ Conventional L~( Other & ie,? 75' t.:l~ 50 f~ ~ Sept Tank: r 00 gallons Pump Tank: C1t9 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch f feet ditches y- feet ditches 74.7 ° 70 inches
French Drain Required: Linear feet
Authorized State ent Date ` 1
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11-5-26639 (2)
11-5-26639 (3)
11-5-26639 (4)
11-5-26639 (5)
11-5-26639 (6)
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11-5-26639 (8)
11-5-26639 (9)
11-5-26639 (10)
11-5-26639 (11)
11-5-26639 (12)
11-5-26639 (13)
11-5-26639 (14)
11-5-26639 (15)
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11-5-26639 (16)