OPHTE# /4~ _ _X~Bito Harnett County Department of Public Health
PERMIT # Operation Pe It 21 71 0
ENew InstallationESeptic Tank Nitrification Line ❑ Renair ❑ Exnansinn
_ PROPERTY LOCATION: 1W(, m- ,Pr
Name: (owner) y = dl' G 77 SUBDIVISION t, LOT # _
System Installer: 0 Registration #
Basement with plumbing: ❑ Garage 2644umber of Bedrooms
Type of Water Supply: ❑ Community Public El 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
PERMIT CONDITIONS:
1. r'ertormance: system shall perform to accordance with Rule .1961.
II. 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 ifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
H2OLine ❑
PWR Line
Septic Tank: Cl t3 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 1 inches
French Drain Required: Linear feet
Authorized State Ag Date
Alarm ❑
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