OPHTE# —� Harnett County Department of Public Health 23378
PERMIT # � Ol erp atlon Permit
New Installation tfsl, Se tic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: awe
Name: (owner) 11C_:1 cT -} 'Y mM SUBDIVISION LOT #
System Installer: t 1 5 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well V80 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
PERMIT CONDITIONS:
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 operati n c
M
maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El Conventional X Other V' 7" _� Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field *fees t-`c' of each ditch feet ditches feet ditches inches
French Drain Reauired: `� Liaear�cet"�.
Authorized State Agent N "`�.���`�. (� Date I