OPHTE# i�° - i°�° _ Harnett County Department of Public Health
PERMIT # z739 z 0 ep ration Per It 22700
1Z/New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: —f--
Name: (owner) 1 -x SUBDIVISION P LOT #
System Installer: '7? Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community E2r Public ❑ Well Distance from well feet
System Type: Z5 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ie t 6 miamWrt4u to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
0
Rules for Sewaee Treatment and Disposal, and all conditions of
M
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.
M
Permit and Construction Authorization.
❑ 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 EZ Other 2�"°�jV— DU p 5�. Septic Tank: /00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch bb feet ditches feet ditches z inches
French Drain Required: Linear feet
Authorized State Age Date f °- n °) 3
13 -5 -31365 (1)
13 -5 -31365 (2)
13 -5 -31365 (3)
13 -5 -31365 (4)
13 -5 -31365 (5)
13 -5 -31365 (6)
13 -5 -31365 (7)
13 -5 -31365 (8)
13 -5 -31365 (9)
13 -5 -31365 (10)