OPHTE# 8- 5-- _31052 Harnett County Department of Public Health
PERMIT # z ®7 9 0 ep ration Per, it � 22686
2/New Installation 2/
Nitrification Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO •5 1YV I 1.3
Name: (owner) SUBDIVISION - LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 5ePublic ❑ Well Distance from well feet
System Type: Z416 7—,1 �� 6 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must w act Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carol a General Statutes, Rules for Sewage Treatment and Disposal, and all jonditions of the
�a 40t3
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
a
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional [Other Z Z c'"�`'? Septic Tank: _ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Z6 inches
French Drain Required: Linear feet
Authorized State A ent �,4z.t -.-� %��r,.. -ti-s� Date -7 - C y ° /
e