OPHTE# Io-5---,,5 r. 13 Harnett County Department of Public Health
PERMIT # 0 eratio Permit 21 8 4 5
New Installation - Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V\9\g::3 QD
Name: (owner) ~s~~ ~ - SUBDIVISION V,0 -01;i0 LOT # I
System Installer: ' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \00 feet
System Type: 41 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 Larolma beneral statutes, 8ules for sewage treatment ana omsposai, ana an commons of the improvement rermit ana construction eum]FIM1011.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capt ed property.
Type of system: ❑ Conventional Other ,ads cZ C~~x`~ Septic Tank: %000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 feet ditches feet ditches inches
French Drain Required: ar
Authorized State Agent Date C~i3~ a