OPHTE# J1--;7- Zjto Harnett County Department of Public Health
PERMIT /Operation Pe mit 2 2 0 9 5
d New Installation Septic Tank EZ/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ,-7z7 t, 44r z s
j1 tn4 LOT #
Name: (owner) Y?n4 SUBDIVISION ij
System Installer: EA~ 4-5 (3~Nu
Basement - F. r-Registration #
with plumbing: ❑ Garage mber of edro ms
Type of Water Supply: ❑ Community Lei Public ❑ Well Distance from well feet
System Type: ?!nQ, bV ~ 4- 7,727 ,3 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.
Z a 11D
This system has been installed in
co i
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 sewaye- disposal system on the above captioned property.
Type of system: El Conventional O Other M LFy rr.(& 5 Septic Tank: gallons Pump Tank: A r gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch feet ditches ~ feet ditches 24 ?'~S inches
French Drain Required: Linear feet
Authorized State A t Date
Permit and Construction Authorization.