OPHTE# Je'..-!; " Harnett County Department of Public Health
PERMIT # 77VZ5° Vpt!FdLIUII rC11111L ` ` - ° %.0
Ed New Installation ®`" Septic Tank ED/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 6*)'t- ti 11
Name: (owner) BDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage [ir Number of Bedrooms
Type of Water Supply: El Community El Public Well Dist nce from well /w ° feet
System Type: °l `psi ✓ " s �' e and VI Systems expire in 5 years.
(In accordance with Table V a) Awner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
II. 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 ❑
fi
Pump El Alarm
El H2O1-ine ❑ PWR Line
Following are the
specifications for the sews disposal system on the above captioned property.
Others ' �t� �-
Septic Tank: � Pump Tank: gallons
Type of system:
❑ Conventional
gallons
Subsurface
Drainage Field
No. of
ditches 2—
exact length
of each ditch feet
width of depth of
ditches 3 feet ditches -74 inches
French Drain Required: Linear feet
Authorized State Ag Date
12 -5 -29490 (2) 12 -5 -29490 (3) 12 -5 -29490 (4) 12 -5 -29490 (5) 12 -5 -29490 (6)
12 -5 -29490 (7) 12 -5 -29490 (8) 12 -5 -29490 (1)