OPNTE# :�-� w Harnett County Department of Public Health 23218
PERMIT # ,% 15' /Operation Per it
New Installation Septic Tank alitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: i
Name: (owner) e SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 2" mber of Bedrooms 3
Type of Water Supply: El Community Lag" Public El Well Distance from well feet
System Type: ' — % T _c pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con ct Health Department 6 months prior to expiration for permit renewal.
rcnrui cununwnr.
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal _ystem on the above captioned property.
Type of system: ❑ Conventional Other Z �, t °�5 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch G D feet ditches feet ditches y�� inches
French Drain Required: Linear feet
Date
Authorized State Ag t �4C
t
13 -5- 32306(2)
13 -5 -32306 (3)
13 -5 -32306 (4)
13 -5 -32306 (5)
13 -5 -32306 (6)
13 -5 -32306 (7)
13 -5 -32306 (1)
13 -5 -32306 (8)
13 -5 -32306 (9)
13 -5 -32306 (10)
13 -5 -32306 (11)