OPHTE# r Z- s.-_ 55i, / Harnett County Department of Public Health
PERMIT # 4-70'r Operation Permit 22481
[Z' New Installation L7" Septic Tank 2" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:4,,.Zy -'1 r van r
Name: (owner) tix 1 SUBDIVISION LOT #
System Installer: - Registration #
Basement with plumbing: ❑ GarQe umber of Bedrooms
Type of Water Supply: ❑ Community ❑' Public ❑ Well Distance from well 05 feet
System Type: Z LU— Dt2ZA1 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.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑
H2O& ❑ PWR Line
Following are the specifications for
the sewa a disposal system on the above captionead property.
Type of system: ❑ Conventional
E2r Other 751 pit r,+'
Septic Tank:
i 2
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
2�,' > t inches
Drainage Field ditches
of each ditch 1 S-0 feet
ditches
feet ditches
French Drain Required:
Linear feet
Authorized State
Date
12 -5 -29561 (1)
12 -5 -29561 (2)
12 -5 -29561 (3)
12 -5 -29561 (4)
12 -5 -29561 (5)
12 -5 -29561 (6)
12 -5 -29561 (7)
12 -5 -29561 (8)
12 -5 -29561 (9)
12 -5 -29561 (11)
12 -5 -29561 (12)
12 -5 -29561 (13)
12 -5 -29561
12 -5 -29561 (10)