OPHTE# 13` -5+ -_° 057 Harnett County Department of Public Health
PERMIT # Z TZ T7 . Operation F1 it ° 2 2 6 5 4
[?/New Installation V Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 6-MIS-6o f-4, rU3
Name: (owner) Cu AjZ_ e.l SUBDIVISION LOT # —�
System Installer: Registration #
Basement with plumbing: ❑ Gara ❑ um er of Bedrooms Z
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: , 55' o�, &a ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) 7 Owner must contact flealth Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
11. 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 sewa a disposal system on the above captioned property.
Type of system: ❑ Conventional 19 Other v Septic Tank: 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 03 feet ditches inches
French Drain Reauired: Linear feet
Authorized State Ada:�,''� �-- !!o c Date _ 4~ 101-13
13 -5 -30576 (1) 13 -5 -30576 (2) 13 -5 -30576 (3) 13 -5 -30576 (4) 13 -5 -30576 (5)