OPHTE #_3 - -3ca(_ Harnett County Department of Public Health ry p
PERMIT # Z;7' :36 O� ration Permit 2 2 6 9 0
New Installation � Septic Tank 2/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: —A2 00s;' gr /Z/)
Name: (owner) hb f 6 SUBDIVISION _� LOT # _
System Installer: Registration #
Basement with plumbing: ❑ Garage � umber of Bedrooms
Type of Water Supply: El Community L� Public ❑ Well Distance from well feet
System Type: 2591X `r2 - %r-,i % ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) v Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications
for the sews a disposal
system on the above captioned property.
Type of system: ❑
Conventional Z Other
Z14—'c j?*i) L r) 5v-A'
Septic Tank: / 0&0 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
"
Drainage Field
ditches
of each ditch ! 7.t`, feet
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age t Date"' �� f