OPHTE# 1'4 —s --33"77 Harnett County Department of Public Health 23778
PERMIT # 1-7 F Operation Per it
Z/New Installation Y Septic Tank l/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: l 3D1 13
Name: (owner)3r fill SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community I?r Public ❑ Well Distance from well feet
System Type: 5® RUU tt es V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact ealth 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 s4age disposal system on the above captioned property.
Type of system: ❑ Conventional 111 Other 25-'X t66W ca Septic Tank: I gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State A t Date