OPHTE #,/q- 5 --3-z,; 4 Harnett County Department of Public Health '
PERMIT # 7`I / Operation Per it it
LX New Installation Septic Tank Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:.zsnJ4t'J
Name: (owner) Co r l {4vr- -< :, 7A t. SUBDIVISION l%1 LOT # I
System Installer: ,+'a e1 ° __ � Registration #
Basement with plumbing: ❑ Garage E1' Pu mber of Bedrooms _�✓
Type of Water Supply: ❑ Community LT Public ❑ Well Distance from well e t
System Type: ?mot Types nd VI Sys ems expire in 5 years.
(In accordance with Table V a) Owner milst conta a th Department months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes,
and allkonditions of the Improvement Permit and Construction Authorization.
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60314M
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. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional EX Other Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2— of each ditch )2,6 feet ditches -' feet ditches 28-518 inches
French Drain Required: Linear feet
Authorized State A nt_ `!�� Date
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