OPHTE# 55- .30-70 Harnett County Department of Public Health
PERMIT # 27319 `7 Operation PPerit / 22688
New Installation l� Septic Tank Q Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2.r't � fr?
Name: (owner) t0 SUBDIVISION LOT #
System Installer: bi t4 /6 iYtc Registration #
Basement with plumbing: ❑ Garage El /Number of Bedrooms .3
Type of Water Supply: ❑ Community C Public ❑ Well Distance from well feet
System Type: Z`'rl'o ► 7i -r= G. rZ 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.
C.- 1� "�'! C
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 sewa ge disposal system on the above captioned property.
Type of system:
❑ Conventional 9 Other
Zelo MIMIUCA 5,,4-A_
Septic Tank: MZ? gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 4
of each ditch feet
ditches 3 feet ditches ZZ inches
French Drain Required: Linear feet
Authorized State A e Date `��