OPHTE#_/b Z5_: Harnett County Department of Public Health
PERMIT # Z4,091 d, Operation Pe,~mit f 21 71 6
New Installation D Septic Tank l /Nitrification Line ❑ Reoair F-1 Exnancinn
PROPERTY LOCATION: -lti5Z 2A
Name: (owner) SUBDIVISION LOT # c-
System Installer: /~~cfyP~ emu; Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms ,_3
Type of Water Supply: ❑ Community I/ 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
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
and all conditions of the Improvement Permit and Construction Authorization.
i
System shall perform in accordance kith 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
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional OtherSeptic Tank:1 0 0 gallons Pump Tank: gallons
Subsurface No. of exact le With width of depth of
Drainage field ditches 2, of each ditch 15-0 feet ditches feet ditches Zj inches
trench Drain Required: Linear feet
Authorized State Age Date 2- 19 - ( I
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10-5-25530 (1) 10-5-25530 (2) 10-5-25530 (3) 10-5-25530 (4) 10-5-25530 (5)
10-5-25530 (6) 10-5-25530 (7) 10-5-25530 (8) 10-5-25530 (9) 10-5-25530 (10)
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10-5-25530 (11) 10-5-25530 (12) 10-5-25530 (13) 10-5-25530 (14) 10-5-25530 (15)
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