OPHTE# Dcl -56D- S)) C-1~ Harnett County Department of Public Health 2 0 7 4 3
PERMIT # (v~[ eratlon Permit
New Installation Septic Tank ❑ Repair` Nitrification Line ❑ Expansion
PROPERTY LOW
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Name: (owner) ` SUBDIVISION 7 LOT
System Installer. - Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water S ly: ❑ Community V Public ❑ Well Distance from well feet
System Type: _ Z ITT 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.
uu> ~ptem nm unen outauea in compnance wan appicame motto Lamina beneral Statutes Rules for Sewage. Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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VV"111VI,J.
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.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sposal system o the above captioned property.
Type of system: ❑ Conventional r - 7---E 1, C/ Septic Tank: 16 ,3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch S feet ditches feet ditches_ inches
French Drain Required: _ Linear feet
Authorized State Agent t,,-~~y ~ Date V ~ v OD-0
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