OPHTE# Harnett County Department of Public Health
PERMIT # a-) 34
Name: (owner) `Yrt vi ,� a U t:� 1 0
System Installer: PL-yrt-'e,�rzi
Basement with plumbing: ❑ Garage Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well
System Type:
(In accordance with Table V a)
Operation Permit 22823
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Qom,
SUBDIVISION �— 25 ,oc£ LOT # CS
Registration #
L
Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable north Larolma General matutes, Rules for )ewage treatment and visposal, and all conditions of me improvement rermlt and Lonstruction AUtnorization,
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Na
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 'F-4, �L-o w Septic Tank: t 0::�)O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches `3 of each ditch � ® feet ditches feet ditches inches
French Drain Reauiredsa
t3- 5366 S'i