OPHTE# -57- Z7M5 Harnett County Department of Public Health
PERMIT # Operation Pe it 2 2 0 6 2
2 New Installation Seatic Tank /Nitrification Line ❑ Reaair ❑ ExDansion
PROPERTY LOCATION: / 60
Name: (owner) 7 x-A ,4 Z;7 me-f-)oZ SUBDIVISION LOT # 2.
System Installer: / Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: El Community ublic ❑ Well Distance from well feet
System Type: Types V and VI Systems xpire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 m the prior to expiration for permit renewal.
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PERMIT CONDITIONS:
1. 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 ❑
Following are the s ihcations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch 100 feet
H2OLine ❑
PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 7-1 inches
French Drain Required: Linear feet
Authorized State A ent 62S~4j Date
Alarm ❑
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