OPHTE# t'77-5 )l�'�Harnett County Department of Public Health 23510
PERMIT # Z 5780 Operation Pe It
New Installation 4 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO
Name: (owner) SUBDIVISION LOT # 33
System Installer: 1 r Registration #
Basement with plumbing: ❑ Garage [Z�Number of Bedrooms
Type of Water Supply: ❑ Community E;? Public ❑ Well Distance from well feet
System Type: v` Pz Types V and VI Systems expire in 5 years.
(In accordance with Table V a) It Owner must contaq Health Department 6 months prior to expiration for permit renewal.
[his 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
N
G;>
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew!je disposal system on the above captioned property.
Type of system: ❑ Conventional 3 OtherZ;-0/0 4zyL— Septic Tank: / ao gallons Pump Tank: 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 Agcntm l � Z— Date
07-5-16961 (1) 07-5-16961 (2) 07-5-16961 (3) 07-5-16961 (4) 07-5-16961 (5)
07-5-16961 (6) 07-5-16961 (7) 07-5-16961 (8)
07-5-16961 (1) 07-5-16961 (2) 07-5-16961 (3) 07-5-16961 (4) 07-5-16961 (5)