OPHTE# IV -15'— 3YI1 s— Harnett County Department of Public Health 23581
PERMIT # ZeQ53 Dperation Perm• /�
New Installation Septic Tank F7 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:�1y/�S
Name: (owner) SUBDIVISION LOT # AL
System Installer: C.rp) Registration #
Basement with plumbing: ❑ Garage ❑�er of Bedrooms
Type of Water Supply: ElCommunity Z Public ❑ Well Distance from well feet
System Type: 4-a Types V and VI Systems expire in 5 years.
(In accordance with Table V a)a ayb It.Lepartment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewa¢e Treatment and`Bisposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
1. 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 ❑
Ifyes, 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 sdisposal s stem on the above captioned property.
Type of system: El Conventional
Conventional Other l`uN� Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch_ feet ditches 3 feet ditches Z6 inches
French Drain Required: Linear feet
Authorized State A nt Dated