OPHTE# Harnett County Department of Public Health
PERMIT # Aeration Permit 21 5 2 3
-I~ New Installation Septic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ocr A 9, < Q- SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorination.
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PERMIT rANI)ITIAW.
I. Performance:
II. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961. 14-- Y
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the _s_pef' dons for the sewage disposal system on the above captioned property.
Type of system: B Conventional ❑ Other Septic Tank: gallons Pump Tank: T gallons
Subsurface No. of J exact length width of 3 depth of
Drainage Field ditches ! of each ditch '7/6 feet ditches feet ditches ~c inches
French Drain Required: Linear feet
Authorized State Agen~ ~'l. & G`~ Date" ate.
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