OPHTE# 13- —10 Harnett County Department of Public Health
PERMIT # 0 ep ration Permit 22854
New Installation Septic Tank trification Line ❑ Repair El Expansion
PROPERTY LOCATIO :�S;
Name: (owner) � } �'� °� t SUBDIVISION \k3-, 1 .F ,o»C 22% 5o m r LOT #
System Installer: Ec> Registration #
Basement with plumbing: ❑ Garage` Number of Bedrooms G ld
Type of Water Supply: ❑ Community Public El Well Distance from well ° feet
System Type: 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other: otJ�
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captij d property.
Type of system: ❑ Conventional Other C- � — ''` Septic Tank: ` d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field . ditches
i of each ditch a' —t5 feet ditches feet ditches inches
French Drain Reauired�` Linear feet
Authorized State Agent 1S Date 1
ti 3- 5.3�D-A