OPHTE# /99vZ"7 Harnett County Department of Public Health 24215
PERMIT # / OperationPermit /
d Neww Installatationn4Septic Tank /Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION;:*r,/5%/
Name: (owner) SUBDIVISION LOT # 1
System Installer. Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms
Type of Water Supply: ❑ Community f3 Public ❑ Well Distance from well feet
System Type: 05316 2 cTiS1—Jar r m�L-es V and VI Systems expire in S years.
(In accordance with Table V a) �T Owneust contictilealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Camlina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Amhoritation
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 sewagYdisposal
system on the above captioned property.
Type of system:
El Co 13� Other
V6 i—WO%) c wry...-..
Septic Tank: 10 oD gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch Rh feet
ditches -3 feet
ditches _2t inches
French Drain Required: Linear feet
Authorized State Date
16-5-39057 (1) 16-5-39057 (2) 16-5-39057 (3) 16-5-39057 (4) 16-5-39057 (5)
16-5-39057 (6) 16-5-39057 (7)