OPHTE# IQ''~; 'Z`*1)'L Harnett County Department of Public Health
PERMIT # 257~t Operation Per-it 21 71 5
ICI New Installation C;~ Seutic Tank Z Nitrification Line ❑ Repair ❑ Exaansion
PROPERTY LOCATION: 'Zi4tc,5 E" Iflo
Name: (owner) SUBDIVISION LOT # JIS
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑V Public ❑ Well Distance from well feet
System Type: 6 1%1_ ' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance:
If. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned roperty.
Type of system: ❑
Conventional d
Other it i -N --1!i
Septic Tank: 00 ® gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches q
exact length
of each ditch W feet
width of depth of
ditches feet ditches 21 inches
French Drain Required:
linear feet
Authorized State Ap
nt /~Y'
/1jffl2J
Date 1