OPHTE# T- 1 Harnett County Department of Public Health
PERMIT # Z-&4LJ7 Operation Flerit 2 2 0 6 5
dNew Installation 2 Septic Tank /Narification Line 1:1 Repair E] Expansion
PROPERTY LOCATION:
Name: (owner) , t SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Be oms
Type of Water Su ly: ❑ Community c Well Distance from well 107 feet
System Type: 5 Qcl- 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:
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property. tz-Z F 0 t- 3
gallons Pump Tank: gallons
Type of system: ❑ Conventional Other T Septic Tank:f 0ID
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 2 to feet ditches feet ditches L2 inches
French Drain Required: Linear feet
Authorized State ent Date ' ~i 1
-z8
f r
5
fff ~
71 t
11-5-26631(2) 11-5-26631 (3)
11-5-26631 (4)
11-5-26631(1)