OPHTE# /o - S- -zST57I Harnett County Department of Public Health
PERMIT # N-0-78 Operation ation P remit 21 7 01
Ci New Installation LfJ Septic Tank 2/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:gle-i
Name: (owner) UBDIVISION LOT # 5
System Installer: C ,!zz Registration #
Basement with plumbing: ❑ arage 131 Number of Bedrooms .3
Type of Water Supply: ❑ Community d Public ❑ Well Distance from well feet
System Type: ISM eAPARYUS) Tpgg 2W C° 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:
1. 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 ❑
H20Line ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned p
®
Type of system:
❑ Conventional Other 1~
u c>
/e / D Uri _ ic Tank: /
gallons Pump Tank: _ gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches 3
of each ditch a feet ditches
feet ditches inches
French Drain Required: Linear feet
Authorized State A . nt Date 11-8-10