OPHTE# /c( -5_, 33309 Harnett County Department of Public Health 23357
PERMIT # Z-7 S 6Z eration Per
Z New Installation Se tic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION: !;,1711Y3
Name: (owner) ( SUBDIVISION V. 4 LOT # LZz--
System Installer: Registration #
Basement with plumbing: ❑ Garage ber of Bedrooms -3
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: t 47- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must coot ct 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 Arat6ent 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.
II. Monitoring: As required by Rule .1961.
111. 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 captioned pro erty 3
Type of system: El Conventional 12 Other 2916,! �c Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches q of each ditch `7 feet ditches —11) feet ditches 79 inches
French Drain Required: Linear feet
Authorized State Ag t '� Date Z`?
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