OPHTE# i`~~s =~~7c~r Harnett County Department of Public Health
PERMIT # 0 erationn Permit Z Nitrification 21 5 6
ZNew Installation f1 Septic Tank IJ~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: r~ R-k.
Name: (owner) SUBDIVISION I~ (~-n f LOT # (,o
System Installer: Gf~d S f~, -L.dcfaK~f' Registration #
Basement with plumbing: ❑ Garage [~KNumber of Bedrooms
Type of Water Supply: ❑ Community 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.
- 31-111 lids ueesi wscanea in compuance wim 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-
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Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Cr
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 sews disposal system on oe above captioned property.
Type of system: ❑ Conventional Other Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 41 Drainage field ditches of each ditch (20 feet ditches 3 feet ditches inches
french Drain Required: Linear feet
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Authorized State Ageryt/-~'; Cll'rIJ Date / 117 ZW-2-
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