OPATE# Harnett Department Public Health
23681
PERMIT # oZb3L9 Operation Pernitit
New Installation Septic Tank Q" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Z'75 -,4Q,,
Name: (owner) SUBDIVISION LOT #
System Installer: -�,/ Co rr— Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ElCommunity L Public ❑ Well Distance from well feet
.�
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) J Owner must contact Health Department 6 months prior to expiration for permit renewal.
tnis system nas been installed in
wltn applicable Nortn Carolina t,eneral Statutes, Rules for Sewage Ireatment and
I
and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. 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:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage/disposal system qn the abov captiongd property.
Type of system: ❑ Conventional Other �u C C� Mf Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 0 of each ditch 7 feet ditches _ �n feet ditches I Y —,7 t✓ inches
French Drain Required: Linear feet p
Authorized State Age (' cw,--� c� -� Date 6 �kovj_
Irk (