OPHTE# /o`f 3,-? Z Harnett County Department of Public Health
PERMIT # mss' 9 c Operation Per It 2 21 6 2
R(New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) -,tc`. (,8~,, j~tprr ~.s c SUBDIVISION Kj--;4-~>u LOT # A.
System Installer: Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms 3
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: G- 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.
Ihis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS: 4
1. rerformance: system span perform in accoraance with Kule I Y61.
II. Monitoring: As required by Rule .1961.
111. Maintenance: 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 sew a disposal system on the above captioned property.
Type of system: ❑ Conventional [Other 5 Z r I d u-1 Septic Tank: 0a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches -3 of each ditch ~o feet ditches feet ditches J Q inches
French Drain Required: Linear feet
Authorized State Agen Date r /3I~ 0 1,2,
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