OPHTE# M — 3 '32 6 Z
PERMIT # -76' v 5
Name: (owner)
System Installer:
Basement with plumbing: ❑ Gar
Type of Water Supply: ❑ Community
System Type:
(In accordance with Table V a)
Harnett County Department of Public Health 23206
0 eration Permit �,/
❑ New Installation ❑ Septic Tank L�' Nitrification Line ❑ Repair Expansion
P OPERTY LOCATION. — j
SUBDIVISION LOT #
Registration #
❑ �1 umber of Bedrooms J
Public ❑ Well Dista a from well feet
Types V and VI Systems expire in 5 years.
Own r must ntact H�aIth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable
4/i� j a-0 E. _ , 1 S
C4° - rte, -U.i: > :4
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North Carolina General Statutes, Aules for
1
and bisoosal, and all conditions of the
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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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 reporting.
Permit and construction Authorization.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional [a Other fvf d`?C?a! - Septic Tank: g gallons Pump Tank: J gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State A nt Date 6 ` 3 °j
14 -5 -33212 (2)
14 -5 -33212 (3)
14 -5 -33212 (4)
14 -5 -33212 (5)
14 -5 -33212 (6)
14 -5 -33212 (7)
14 -5 -33212 (1)
14 -5 -33212 (8)
14 -5 -33212 (9)
14 -5 -33212 (10)
14 -5 -33212 (11)