OPHTE# 1z ---�-- 2570 Harnett County Department of Public Health
PERMIT # Z `1 3 / Operation Pe .mit 22499
C/ New Installation Seutic Tank Y/ Nitrification Line ❑ Reuair ❑ Expansion
PROPERTY LOCATION 1 3 Z6 =czn c' V d "'r `Zip
Name: (owner) 1J4,u,%;C SUBDIVISION LOT # r
System Installer: Registration #
Basement with plumbing: ❑ Garage If Number of_Bed�°ms
Type of Water Supply: ❑ Community 2 Public L7 Well Distance.4rom well ' feet
System Type: Loo V-,gj � `5 ?p Z 15 1 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: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 specs ications for the sewage disposal system on the above captioned property.
Type of system: , Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch i.Z`P feet
French Drain Required: Linear feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: %`� gallons Pump Tank: _
width of depth of
ditches 3 feet ditches
;Zs7 2 is m f
Authorized State AQMT—) L _
-- Date 3°
gallons
inches