OPHTE# 13 - 5- -3Z 'Jy Harnett County Department of Public Health 23362
PERMIT # Z Z i J operation Per
lY New Installation Septic Tank ❑- 1itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:.' /,u —/
Name: (owner) SUBDIVISION LOT # !y3
System Installer: `T ° ,, -L12 Registration #
Basement with plumbing: ❑ Garage C� mber of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well feet
System Type: f,- f ^- ' i %�'2?T'< v—u� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ownerknust 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 Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above cap ned o�
Type of system: ❑ Conventional CYOther 1S01a fl! l Tank: ,f (u J gallons Pump Tank: t gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ems° feet ditches feet ditches `i ~ inches
French Drain Reauired: Linear feet
Authorized State Aga'nt Date Zu