OPHTE# f"Z 198-n Harnett County Department of Public Health
PERMIT # ?&M peratlonn Permit 22291
New Installation Imo` Septic Tank Nitrification Line 1:1 Repair El Expansion
PROPERTY LOCATION:.-1~Y3 Cr~t"i 40
Name: (owner) ?Y-~i ate. !C C SUBDIVISION LOT # 113
System Installer: ' Registration # btkaarf6 Basement with plumbing: ❑ Garage u or o bedrooms
Type of Water Supply: ❑ Community Pu lic ❑ Well Distance from well feet
System Type: Z 45r 0 pes V and VI Syst s expire in 5 years.
(In accordance with Table V a) Oyer rust contact ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nortj Carolina General Statutes,
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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1-5
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Permit and Construction Authorization.
Treatment and Disposal, and all conditions of the
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.
Other:
V
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❑ D-Box ❑
Pump ❑ Alarm ❑
H201-ine ❑ PWR Line
Following are the specifications for the seewwa,&~ disposal system on the above captioned proper 61
Type of system: ❑ Conventional IJ Other Septic Tank:
Subsurface No. of exact ength width of
Drainage Field ditches 3 of each ditch y / 6 feet ditches
~
gallons Pump Tank: gallons
depth of
feet ditches 21- inches
French Drain Required:
Linear feet
Authorized State tent
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Date
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