OPHTE# ,11-5-- ziu z~ Harnett County Department of Public Health
PERMIT # SN s Aeration PPer 2 21 0 0
Z New Installation 13" Septic Tank 3 ,Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION i q ie -><,>Q---
Name: (owner)~Ttr SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms
Type of Water Supply: ❑ Community 0 Public ❑ Well Distance from well feet
System Type: FZ.!• G es V and VI Systems expire in 5 ears.
(In accordance with Table V a) Owzer must contact Heal t~t Department 6 months prior ton for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules a e Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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: 4
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposals stem on the above captioned properj~~,,,,,
42
Type of system: ❑ Conventional Other 72~ ° " Zeptic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch / feet ditches feet ditches Z Z inches
French Drain Required: Linear feet
Authorized State A>nf_ Date r ° - 1