OPHTE# _ Harnett County Department of Public Health 23191
PERMIT # Z"7 -116, Operation Per It
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Ci`f Xo% / 12e SUBDIVISION LOT #
System Installer: ! +.7uc_% t#7o6 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 5
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: Ad V C74- tJ� pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact ealth Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. 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 sewaU disposal system on the above captioned property.
Type of system: ❑ Conventional Other UCJ7. Septic Tank: 1 ��+ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 160 feet ditches feet ditches ZJL inches
French Drain Required: Linear feet
Authorized State A ent - � fl lfs Date " — I I
13 -5 -32615 (1)
13 -5 -32615 (2)
13 -5 -32615 (3)
13 -5 -32615 (4)
13 -5 -32615 (5)
13 -5 -32615 (6)
13 -5 -32615 (11)
13 -5 -32615 (7)
13 -5 -32615 (8)
13 -5 -32615 (9)
13 -5 -32615 (10)