OP RHTE# — � CgZ Harnett County Department of Public Health
PERMIT # 2 -7 30 OO,lDeration Pe it 22699
2' New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 55
Name: (owner) '7r- 0ZUtW—,A— SUBDIVISION LO _
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Xmber of Bedrooms
Type of Water Sup I : El Community I - Public ❑ Well Distance from well feet
System Type: Z' a �' THelth V and VI Systems expire in 5 years.
(In accordance with Table V a) 0 ner must contact Department 6 months prior to expiration for permit renewal.
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:
❑
D -Box ❑
Pump ❑
Alarm ❑ H2O1-ine ❑ PWR Line
ewa
Following are the specifications for the s a disposal
system on the above captioned property.
Type of system:
11 Conventio nal Other
1 A [ ' t 14
Septic Tank: 73 gallons Pump Tank: gallons
Subsurface
No. of
exact length
ditch feet
width of depth of
ditches .3 feet ditches Z4 inches
Drainage Field
ditches
of each
French Drain Required: Linear feet
Authorized State Age Date �� ��
13- 5- 30842R (1)
13- 5- 30842R (2)
13- 5- 30842R (3)
13- 5- 30842R (4)
13- 5- 30842R (5)
13- 5- 30842R (6)
13- 5- 30842R (7)
13- 5- 30842R (8)
13- 5- 30842R (9)
13- 5- 30842R (11)
13- 5- 30842R (12)
13- 5- 30842R (13)
13- 5- 30842R (14)
13- 5- 30842R (10)