OPHTE # -A"Z -z` �� Harnett County Department of Public Health
PERMIT # 2.1 2-1 `i Operation Perm It 22658
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Vl g-4�
Name: (owner) SUBDIVISION LOT # _i
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 0 Public ❑ Well Distance from well feet
System Type: e'0- V - --i L N> 7 Ex U Z) 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 compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
1)
PERMIT CONDITIONS:
I. 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 ❑
Following are the spe ications for the sewage disposal system on the above captioned property.
Type of system: Conventional 2F Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Required: Linear feet
Authorized State
Alarm ❑
Permit and Construction Authorization.
H2OLine ❑
PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches_ inches
Date "i` 21® 1
12 -5 -29961 (1)
12 -5 -29961 (2)
12 -5 -29961 (3)
12 -5 -29961 (4)
12 -5 -29961 (5)
12 -5 -29961 (6)
12 -5 -29961 (7)
12 -5 -29961 (8)
12 -5 -29961 (9)
12- 5- 29961(10)