OPH T E # ; s= s �� 3 z Harnett County Department of Public Health
23611
PERMIT # -Z'9 3 -71 Operation Per 't
"ew Installation Z Septic TankNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Zz/.:5—, �o
Name: (owner)SUBDIVISION_LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Z "ber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ' // Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must c 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 Treatment aW Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtKMII LUNullIUNS:
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 -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew ge disposal system on the above captioned property.
Type of system: ❑ Conventional Other 75'0 /7�7I"Zy` — Septic Tank: gallons Pump Tank: gallons
Subsurface No. of zz exact length r� width of depth of
Drainage Field ditches J of each ditch Z�y feet ditches -3 feet ditches 2'61 inches
French Drain Required: Linear feet
Authorized State AR Date (:�, —L -j' 15"—
15-5-35932 (1) 15-5-35932 (2) 15-5-35932 (3) 15-5-35932 (4) 15-5-35932 (5)
15-5-35932 (6) 15-5-35932 (7) 15-5-35932 (8)