OPHTE# IZ_ ���g 9y Harnett County Department of Public Health
PERMIT # 270 q Operation Per It � 22972
(2' New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: to t
Name: (owner) SUBDIVISION — LOT #
System Installer: l? Registration #
Basement with plumbing: ❑ Garage 2""Number of Bedrooms -5
Type of Water Supply: ❑ Community 2""Public ❑ Well. - Distance from well feet
System Type: 45 t Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must A tact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform 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.
I
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 9 Other 7911 i Ue Septic Tank: /00 0 gallons Pump Tank: 10 a 12� gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch j Z-r+ feet ditches feet ditches 50 �% i inches
French Drain Required: Linear feet
Authorized State Ate_ Date `� "" v
12 -5 -29694 (1)
12 -5 -29694 (2)
12 -5 -29694 (3)
12 -5 -29694 (4)
12 -5 -29694 (5)
12 -5 -29694 (6)
12 -5 -29694 (7)
12 -5 -29694 (8)
12 -5 -29694 (9)
12 -5 -29694 (11)
12 -5 -29694 (12)
12 -5 -29694 (13)
12 -5 -29694 (14)
12 -5 -29694 (10)