OPHTE # Harnett County Department of Public Health
PERMIT # NerationnPerm —it 22380
IJ New Installation Rr Septic Tank 0'—Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: b��tr/��.
Name: (owner) SUBDIVISION % ✓ i- �r �`� g LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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.
This 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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PHMII CUNUIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the specifications for the sewap disposal system on the above captioned property.
Type of system: ❑ Conventional Rr Other C— Z. " ->
Subsurface No. of exact length
Drainage Field ditches oZ of each ditch -7 J'- feet
Alarm ❑ H2O1-ine ❑ PWR Line
— Septic Tank: 6 d 0 gallons Pump Tank: /0 a Cd gallons
width of depth of
ditches feet ditches J L " l8 inches
French Drain Required: Linear feet
Authorized State Agen r ✓"�l7 Date /a w1,2-ffl Z