OP RHTE# 67- - 21050/Z Harnett County Department of Public Health
PERMIT # 1722,"? Operation Permit 22683
New Installation Septic Tank Iii' / Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: it*S-' .S;: m, rg
Name: (owner) i SUBDIVISION Pi LOT #
System Installer: ' -' Registration #
Basement with plumbing: El Garage 12 umber of Bedrooms
Type of Water Supply: El Community L1' Public ❑ Well Distance from well feet
System Type: �5 �,A C �z - T es V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact ealth Department 6 months prior to expiration for permit renewal.
PERMIT rmmnITIM-
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961. 4)
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property .
Type of system: El Conventional 2'r Other Z 6 e ! .X' �✓rrr sc � ptic Tank: 100d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch d feet ditches feet ditches Z inches
French Drain Required: Linear feet
Authorized State Age Date ° Z
07- 5- 1696OR (1)
07- 5- 1696OR (2)
07- 5- 1696OR (3)
07- 5- 1696OR (4)
07- 5- 1696OR (5)
07- 5- 1696OR (6)
07- 5- 1696OR (7)
07- 5- 1696OR (11) 07- 5- 1696OR (12)
07- 5- 1696OR (8)
07- 5- 1696OR (9)
07- 5- 1696OR (10)
07- 5- 1696OR (1)
07- 5- 1696OR (2)
07- 5- 1696OR (3)
07- 5- 1696OR (4)
07- 5- 1696OR (5)
07- 5- 1696OR (6)
07- 5- 1696OR (7)
07- 5- 1696OR (11) 07- 5- 1696OR (12)
07- 5- 1696OR (8)
07- 5- 1696OR (9)
07- 5- 1696OR (10)