OPHTE# 0 4t 29951 Harnett County Department of Public Health
PERMIT # Z7 :_ /OlDeration Permit /� 22298
E New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:._ _ t /,, + w
Name: (owner) �- SUBDIVISION LOT # 1
System Installer: Registration #
Basement with plumbing: ❑ Garage �� ber of Bedrooms 3
Type of Water Supply: L1 'Community L Public ❑ Well Distance from well feet
System Type: � y & 4c-'- pes V and VI Systems expire in 5 years.
(In accordance with Table V a) 6 Owner must contact ealth Department 6 months prior to expiration for permit renewal.
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 ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew)&
disposal system on the above captioned property.
Type of system:
❑ Conventional 3 Other
1S'�� c ta)
�—
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 3
of each ditch ib feet
ditches -� feet ditches -Z. inches
French Drain Required: Linear feet
Authorized State ent Date 5--/ —
12 -5 -28951 (2)
12 -5- 28951(3)
12 -5 -28951 (4)
12 -5 -28951 (5) 12 -5 -28951 (6)
12 -5 -28951 (7)
12 -5 -28951 (8)
12 -5 -28951 (9)
12 -5 -28951 (1)