OPHTE# )3 31- 74n(ra Harnett County Department of Public Health
23193
PERMIT Operation�Perwit
2/New Installation lir Septic Tank C7' Nitrification Line ❑ Repair ❑ Expansion
P P
PROPERTY LOCATION: ' (0-0 46
Name: (owner) SUBDIVISION LOT # 2..
System Installer: 22 Registration #
Basement with plumbing: ❑ Garage Eumber of Bedrooms 3
Type of Water Supply: El Community L� Public ❑ Well Distance from well feet
System Type: Ila 6 -Fe Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con act 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
and all conditions of the
1`
System shall perform in accordance with 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 Ieration conditions, mainten ce and reporting.
rt
Permit and Construction Authorization.
❑ D -Box ❑ Pu�p ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewagge disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1591fO&V U f7",2' Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches feet ditches 2.q a 14, inches
French Drain Reouired: Linear feet
Authorized State A --,.. _ �_ ,%'� ,�,. "�`� Date V — 7 7 a-/ �Z
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