OPHTE# I-5-4LSSq- Harnett County Department of Public Health 24965
PERMIT #05!!S6 Aeration Permits �
Z New Installation Q'Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ]j Gold short c� �5%
Name: : (owner) 1pp;S2Mnc%;ge ?6t-L6SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bums ._
Type of Water Supply: ❑ Community ❑ Public V Well Distance from well 116' feet
System Type: J vTypes V and VI Systems expire in S years.
(In accordance with Table V a) must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance oath applicable hens 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: 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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage . osal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: 1<! > gallons Pump Tank: gallons
Subsurface No. of,, ii exact length 3 width of depth of
Drainage Field ditches 4— of each ditch "f'"J feet ditches 3 feet ditches 04— inches
French Drain Required: Linear feet
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