OPHTE# i1-s-a7~ Yz3 Harnett County Department of Public Health
PERMIT # oZ yU 0 eration Permit 2 2 0 4 2
RKNew Installation 2er" Septic Tank Nitrification Line ❑ Repair ❑ Expansion
/1 ( PROPERTY LOCATION- Wr 11
Name: (owner) SUBDIVISION wa er LOT #
System Installer: AAA Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 5
Type of Water Supply: ❑ Community 0 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 Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS: Y5r%~ C, Az
1. Pertormance: Nystem 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 01
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Following are th
e specifications for the
Type of system:
❑ Conventional
Subsurface
Drainage Field
No. of
ditches
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sews disposal system on the bove aptioned property.
EiY Other v ` c _ 4' t~ -Septic Tank: / 'G gallons Pump Tank: gallons
3 exact length 8 0 width of depth of
of each ditch feet ditches feet ditches c inches
French Drain Required: Linear feet
Authorized State Agent Date it- Zap/
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