OPHTE# 3-5"- 30�1-/ Harnett County Department of Public Health
PERMIT # 3 7 .o e ration Per It 22978
Z New Installation 12rSeptic Tank e Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ,/ a %s)
Name: (owner) - — SUBDIVISION LOT #
System Installer: ] ,J�A Registration #
Basement with plumbing: ❑ Garage ❑ mber of�Be�d,.r�°ms _,:
Type of Water Suppl : ❑ Community Public L-� Well _Distance from well ��� feet �/ ? 2 c
System Type: Z N% _1&7�>Ul Z(I1 `s,�- 1�.G�e '�" Types V and VI Systems expire in 5ars.
(In accordance with Table V a) v Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
rrvi
all conditions of the
r�
AL
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.
Permit and Construction Authorization.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewagg disposal system on the above captioneNoperty.
Type of system: ❑ Conventional Eir Other 7M Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2- of each ditch f feet ditches -3 feet ditches - inches
French Drain Required: Linear feet
Authorized State Ag Date
13 -5 -30971 (1)
13 -5 -30971 (2)
13 -5 -30971 (3)
13 -5 -30971 (4)
13 -5 -30971 (5)
13 -5 -30971 (6)
13 -5 -30971 (7)
13 -5 -30971 (8)
13 -5 -30971 (9)
13 -5 -30971 (10)