OPHTE# t2° 9- Harnett County Department of Public Health
PERMIT # 1,71-4 ID Operation Per it 22678
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 0r/b , � _r�-� SUBDIVISION LOT #
System Installer: -J" Registration #
Basement with plumbing: ❑ Garage C"Number of Bedrooms
Type of Water Supply: ❑ Community 2"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 contac health Department 6 months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
N
r
L
Ia
ystem shall perform in accordance with Rule .19 I.
required by Rule .1961.
As required by Rule .1961. Other:
Sub urface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation ct
❑ D -Box ❑ Pum -'' Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Eir Other %V,� Septic Tank: /'0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / feet ditches 3 feet ditches 7— inches
French Drain Required: Linear feet
Authorized State Age Date L— 13 "13
12 -5 -29858 (1) 12 -5 -29858 (2) 12 -5 -29858 (3) 12 -5 -29858 (4) 12 -5 -29858 (5)
12 -5 -29858 (6) 12 -5 -29858 (7) 12 -5 -29858 (8)