OPHTE# /0-E `-1r/73` Harnett County Department of Public Health
PERMIT # ZiLl 3e Operation ation Pe mit 21 81 7
® New Installation 21 Septic Tank I?1 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) G, -r y to 1,1 #1,JQ SUBDIVISION LOT #X26
System Installer: < -tr'c OSA Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms .3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: ]:ITM G_ 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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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
111. 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:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal ~ystem on the above captioned property.
Type of system: ❑ Conventional Other 12~ Fr/oL,_' Septic Tank: / 00 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch L C) feet ditches feet ditches 0 inches
French Drain Required: Linear feet
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Authorized State Agen Date ~