OPHTE# /4- S' -3,3Z Harnett County Department of Public Health 23591
PERMIT # 4_8 z-1 '7Operation Per it
L� New Installation Y Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: !(-g ss
Name: (owner) SUBDIVISION LOT #
System Installer: ae Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community RT Public ❑ Well Distance from well feet
System Type: 5'N5 �n ?� and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must t ealt Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
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.
IV. Operation:
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwa�'disposal system on the above captioned property.
Type of system: El Conventional L1 Other 2 S' o
Septic Tank:d/ Il' gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch ® feet
width of depth of
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date
14-5-35205 (1)
14-5-35205 (2)
14-5-35205 (3)
14-5-35205 (4)
14-5-35205 (5)
14-5-35205 (6)
14-5-35205 (11)
14-5-35205 (7)
14-5-35205 (8)
14-5-35205 (9)
14-5-35205 (10)