OPHTE#�'�;:- -t -:36�� < Harnett County Department of Public Health 2379-0
PERMIT #0 en� ation Permit
W//New Installation Septic Tank 2/ Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION•
Name: (owner) SUBDIVISION LOT #_
System Installer: ��:i 5 �" Reg ration #
Basement with plumbing: ❑ Garage Number of Bedrooms `]
Type of Water Supply: ❑ Community � Public ❑ Well Distat%e from well feet
System Type: �� !fir} Z e :— T C t 'Types nd VI Systems expire in 5 years.
(In accordance with Table V a) 11,6wner must cont& Health Dep ment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Generaflstatutes, Rules for Sewage Treatment and Disposal, anal conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
ll. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewags disposal system on the above captioned property. _
Type of system: El Convent- [� Other Septic Tank: 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches �> feet ditches inches
French Drain Reauired: Linear feet
Authorized State. A �- �+�— - Date 1
15-5-35521 (1)
15-5-35521 (2)
15-5-35521 (3)
15-5-35521 (4) 15-5-35521 (5)
15-5-35521 (6)
15-5-35521 (7)
15-5-35521 (8)
15-5-35521 (9)