OPHTE# I2.- - Z 9ZO 7 Harnett County Department of Public Health
PERMIT # Operation Pe it 2 2 2 9 0
I New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
S;~
Name: (owner) 4~ a-- X SUBDIVISION Qu uA a LOT #
System Installer: . J Registration #
Basement with plumbing: ❑ Garage Z )umber of Bedrooms q
Type of Water Supply: ❑ Community E2' Public ❑ Well Distance from well feet
System Type: 2s'Gi,~ r R~ 75i,sk-, :7j ~ .u-i 6 - 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.
This system has been installed in
Permit and Construction Authorization.
U 1TI
PERMIT CONDITIONS:
1. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box
❑ Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the spe
cifications for
the sews a disposal system on the above captioned property.
Type of system: El
Conventional
Other s 02, y).> s "T
Septic Tank: , 7-0 6 ` gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
_
of each ditch / S y feet
ditches 3 feet ditches L~ inches
French Drain Required: Linear feet
Authorized State Age Date ° 1Z
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Impr
a
12-5-28207 (1)
12-5-28207 (2)
12-5-28207 (3)
12-5-28207 (4)
12-5-28207 (5)
74
>
o
12-5-28207 (6)
12-5-28207 (7)
12-5-28 07
12-5-28207 (9)
12-5-28207 (10)
.
s
12-5-28207 (11)
12-5-28207 (12)
12-5-28207 (13)
12-5-28207 (14)
12-5-28207 (15)
,
w
n
v'
p ✓
y
12-5-28207 (16)
12-5-28207 (17)
12-5-28207 (18)
12-5-28207 (19)
12-5-28207 (20)
y
12-5-28207 (21)