OP RHTE# I' -'t5- - f Harnett County Department of Public Health 23784
PERMIT # 2"ey-7-5' Operation Per -milt
M New Installation ZteSeptic Tank 12/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION zyz 4 =�� 4 � /L
Name: (owner)SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community li� Public ❑ Well Distance from well feet
System Type: 9z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must co tact 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 and Disposal, and all conditions of the Improvement Permit and Constructi4 Authorization.
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PERMIT CONDITIONS:'—
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 -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
Type of system: ❑
for
Conventional
the sewage disposal system on the above captioned property.
21" Other ?S% P---�O t- z — Septic Tank:
10 y b gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length width of
of each ditch 100 feet ditches
depth of
feet ditches 2 inches
French Drain Required: Linear feet
Authorized State A nt 7 �f Date
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15-5-36633R (6) 15-5-36633R (7)
15-5-36633R (8)
15-5-36633R (9)
15-5-36633R (10)