OPHTE#
PERMIT # S13
Name: (owner)
System Installer:
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: 4�vz:a-Z
(In accordance with Table V a)
This system has been installed in compliance with a
Harnett County Department of Public Health
Operation Perm�it ,r' 23012
2/New Installation 5? Septic Tank LR' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:--'-i� � 40
` SUBDIVISION LOT #
Relistration #
'ubli '�EII Distance from we feet
° deZ T" — 6- F71. pes V and VI Systems expire in 5 years.
a Owners st cont c ealth Department 6 months prior to expiration for permit renewal.
4
and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 0 eration•
p
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications
for the sews
[Other
disposal system on the above captioned property.
`5""
Type of system: El
Conventional
c %v yZP ;1�UU
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of i
exact length 3aO
width of depth of
Drainage Field
ditches
of each ditch &4) feet
ditches '3 feet ditches inches
French Drain Required: Linear feet
Authorized State Age Date
v
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Y
c
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