OPHTE# ry -s7- -34777 Harnett County Department of Public Health 23324
PERMIT # L 773( , 0O er_ ration_Permit
r? New Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONLW -A$ 40
Name: (owner) SUBDIVISION LOT #
System Installer: rs Registration #
Basement with plumbing: ❑ Garage ❑ jumber of Bedrooms
Type of Water Supply: ❑ Community 1Z Public ❑ Well Distance from well feet
System Type: i G RL 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.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .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 operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ 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 C"Other 15'h Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch (Do feet ditches feet ditches inches
Frenrh Drain Renuired: Linear feet
Authorized State Date
14 -5 -32977 (2)
14 -5- 32977(3)
14 -5 -32977 (4)
14 -5 -32977 (5)
14 -5 -32977 (6)
14 -5 -32977 (7)
14 -5 -32977 (8)
14 -5 -32977 (12) 14 -5 -32977 (1)
14 -5 -32977 (9)
14 -5 -32977 (10)
14 -5 -32977 (11)