OP RHTE #) - objt? Harnett County Department of Public Health
PERMIT # Z -7 �3 Operation Per it 22500
® New Installation .�, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: a Fie c -i
Name: (owner) -5 4�_, SUBDIVISION LOT #
System Installer: ,£ Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms 3
Type of Water Supply: El L�!f Community Public ❑ Well Distance from well feet
System Type: Z 59G iV --_—N cf2 --tl , • �✓..� --- % ,a.� `Z 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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
M
System shall perform in accords e v ith 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.
y
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pro erty.
Type of system: ❑ Conventional Others /� r2:'Zi�t r ��1 °�''^ Septic Tank: i 6 �' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Co w' feet ditches 3 feet ditches 7 inches
French Drain Required: Linear feet
Authorized State Ageli P7 Rai — Date