OPHTE# 14 -5-J Z1 Harnett County Department of Public Health
23363
PERMIT # 7 --797 �� eration Pe it
L,d New Installation Septic Tank C�' Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION:Ajq -?q 04
Name: (owner) SUBDIVISION :J-5 .—, LOT # 't �
System Installer Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms 3
Type of Water Supply: ❑ Community Q' Public ❑ Well Distance from well feet
System Type: na Types V and VI Systems expire in 5 years.
(In accordance with able V a) U- 0 ner must contact Health Department 6 months prior to expiration for permit renewal.
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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.
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 property.
Type of system: El Conventional E ew Other Septic Tank: gallons Pump Tank: ! 49 0 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch %b feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State A�gut /�( �' Date
14 -5 -33621 (4) 14 -5 -33621 (5) 14 -5 -33621 (6) 14 -5 -33621 (7) 14 -5 -33621 (8)
14 -5- 33621(1) 14 -5- 33621(2) 14 -5- 33621(3)