OPHTE# 13 -5- -3 ,,yzS' Harnett County Department of Public Health
PERMIT # z z 41 0 erg ation Pe It 22669
EZ New Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5'NLf GUY Itts
Name: (owner) 61 SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ 1 Garage Number of Bedrooms_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: S ] 3 pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner Ct contact ealth Department 6 months prior to expiration for permit renewal.
PERMIT -CONDITIONS:
I. Performance:
System shall perform in accordance with Ilule .1961.
II. 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 peration conditions, maintenance a d reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump El H2OLine ❑ PWR Line
Following are the specifications for the sewap disposal system on the above capti one d• property. 0
Type of system: ❑ Conventional Other Z!9% Septic Tank: — 6 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch i d feet ditches feet ditches le inches
French Drain Required: Linear feet
Authorized State Ag
Date