OPHTE# I • - S " yd 2 Harnett County Department of Public Health 241 9A
PERMIT # 0 ,.�/ Operation Permit �/
LAS ew Installation 9-5iptic Tank L� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION
Name: (owner) SUBDIVISION LOT # S /
System Installer: /- Registration #
Basement with plumbing: ❑ Garage ❑� �Neu ober of Bedrooms
Type of Water Supp • ❑ Community f ublic ❑ ell Distan from well feet
System Type: Pz• — � �,>g��
�s�:��^`i ,e..__�- Types V and VI Systems expire in S yeah.
(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 Geneml Statute% Rules for Sewage Tmaunem and disposal, and all conditions of the Improvement Permit and Consnoon Authorization.
QI.
C
PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. /
Eg-' J D -Box
❑ Pump ❑ Alarm ❑
M2OLine ❑
Following are the specifications for the sewa a disposal system on the above ca tionRd pro try. 6Z
Fkr-
Type of system: ❑ Conventional Other X� V �Q Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 7 of each ditch feet ditches 3 feet ditches
French Drain Required: Linear feet `l
Authorized State Agent t E—A-5- Date
PWR Line
gallons
inches