OPHTE#-i°-J =a~Harnett County Department of Public Health
PERMIT # a~ ~z 0 eration Permit 21 5 4
New Installation sent Tank ET Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION cn
System Installer. LOT #
`L/`'„4 Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 91 Public ❑ Well Distance from well
System Type: feet
(In accordance with Table Y a) Types Y and VI Systems expire in 5 years.
Owner must contact 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 Construction Authorization.
AL
~ L
Ka„'! -
'D
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
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other
❑ D-Box ❑ Pump ❑
Alarm ❑ H20Line ❑
following are the specifications for the seewwsgre-disp Z f~c osal s tem ytq the above captioned property. PWR Line
Type of system: ❑ Conventional LP' Otherti,,
Subsurface No. of Septic Tank: gallons Pump Tank:-7`
exact length width of gallons
Drainage field ditches of each ditch ~6 depth of
french Drain Required: Linear feet feet ditches 3 _ feet ditches inches
Authorized State Agent rij~
Date qc a
`s