OPHTE# Id--s- el6,3 Harnett County Department of Public Health
PERMIT # cZ ~-7 1 f
Name: (owner)
System Installer:
Basement with plumbing: ❑ Garage ❑ Number of Bedroom
Type of Water Supply: ❑ Community GZPublic ❑ Well
System Type: -LLL G
(In accordance with Table V a)
Operation Permit 2 2 3 6 0
2" New Installation 2 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
SUBDIVISION 7'rnttefd 2,'Ll s~ LOT # 9 b
Registration #
Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Larohna General Statutes, Rules for Sewage Ireatment and Uaposal, and all conditions of the
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. 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 s disposal system on the above captioned property.
Type of system: El Conven ewa
tional Other C- -2- Floes Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / O d feet ditches 3 feet ditches U is - 15 inches
French Drain Required: Linear feet
Authorized State Agen - Date CZ/ Z