OPHTE# ia-6- 3Y7~4 Harnett County Department of Public Health
PERMIT # d erg ation Permit 21 5 5 b
0""New Installation e er Septic Tank R"'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner)SUBDIVISION LOT #
System Installer: "T-QAC Jc'P i= c Registration #
Basement with plumbing. ❑ Garage 2 Number 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 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.
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1. Performance: System shall perform in accordance with Rule .1961.
IL 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 ❑
Following are the sp~tcations for the sewage disposal system on the above captioned property.
Type of system: 9 Conventional ❑ Other
Subsurface No. of exact length
Drainage field ditches 12 of each ditch --5~ feet
H2OLine ❑
Septic Tank: f" gallons Pump Tank:
width of depth of
ditches feet ditches le
PWR Line
gallons
inches
French Drain Required: Linear feet
Authorized State Agen 7, -4 7~c-,': .r ~ Date Io 4~ /c~
Alarm ❑
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