OPHTE# j6 -s- aY/ 89 Harnett County Department of Public Health 21
PERMIT # a 69 0
Name: (owner) ~-~V,,,
System Installer: d `
Basement with plumbing: ❑ Garage 2 Number of Bedrooms
Type of Water Supply: ❑ Community 2''Publi( ❑ Well
System Type:
(In accordance with Table V a)
This system has been installed in compliance with applicable North Carolina General Stai
9
0 ergt q ~P-e-t 31
~ew Installation P~ rm- i Septic Tank ❑ Repair B'Nitrification Line ❑ Expansion
PROPERTY LOCATION:
SUBDIVISION LOT #
Registration #
Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
utes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
")Cj" I b1,
PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Following are the specifications for the sewa~
Type of system: ❑ Conventional
Subsurface No. of
Drainage field ditches
French Drain Required:
V /J- t J"' rat
le dispos system on the above aptioned property.
Other n1- 10 C- 2 Se tic Tank:
exact length p gallons Pump Tank: . ZOG gallons
width of
of each ditch _ `'t` _ feet ditches ~ depth of
,,_-Linear feet feet ditches inches
Authorized State AgeKt ` . ,/71;:714V
2
Date , ~f C~
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 operation conditions, maintenance and ronnrti-