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OP RV11 1141 FITE# 1 PERMIT # ! 1 ' ` Name: (owner) System Installer: I Basement with plumbing: ❑ Type of Water Supply ❑ Co System Tyne: (In accordance with Table V a) This system has been installed in Harnett County Department of Public Health 23201 Operation Per it El--'New Installation Z Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LO(ATION: SUBDIVISION LOT # • ��, °k Registration # ©,; Number of Bedrooms 3 v Public ❑ Well Distance from well feet — 1 i" . ° °,,, X7 C s` `r tom, pes V and VI Systems expire in 5 years uolicable North Carolina General n� yJ s1 c Owner must contact Health Department 6 months prior to expiration for permit renewal. atu4, Rules for Sewage Treatment and Disposal, and all conditions of the r _ ` l>r � ti PERMIT CONDITIONS: I I. Performance: System shall perf rm in accordance with Rule .1961. II. Monitoring: As required by R le .1961. III. Maintenance: As required by R e .1961. Other: Subsurface system ope require . es No If yes, see attached sheet for additional operation conditions, IV. Operation: iV andTe°pting. Permit and Construction Authorization. V. Other: ❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line Following are the specifications for the sewa disposal system on the above captioned property. Type of system: El Conventional Other VW Septic Tank: 1 0,,,) gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage field ditches Z_ of each ditch Z_ 6 feet ditches e feet ditches Z2 ._11e -� inches French Drain Required: Linear feet Authorized State Ageht -.�- = � � ---� °� `°'- ---�~' Date