OPHTE# /0-, V~'? ~ Harnett County Department of Public Health
PERMIT # a (-Cqr Operation Permit 21 5 2 5
RJ---New Installation Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
{ PROPERTY LOCATIO f.11.&.
Name: (owner) SUBDIVISION
dti~ LOT 11, System Installer.--s ry~ Registration #
Basement with plumbing ❑ Garage E~'N ber of Bedrooms
Type of Water Supply: ❑ Community L►' 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.
1hrs system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
L renurmance: system snap perform in accordance with Rule .IY61.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No El'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
- c O
er C~ `T
❑
D-Box ❑
Pump ❑
Alarm ❑ 1-1201-ine ❑ PWR Line
Following are th
e speci~f ations for the sewage disposal
'
system on the above captioned property.
Type of system:
2
Conventional ❑ Other
Septic Tank: gallons Pump Tank gallons
Subsurface
No. of
exact length
'
width of depth of
Drainage field
ditches
of each ditch
7 feet
ditches 3 feet ditches ly inches
French Drain Required: Linear feet
Authorized State Agen wL/~ Date 24 V~2--Z~lu
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