OPHTE# Harnett County Department of Public Health 23708
PERMIT # o283s'y Operation gFewrittw Installation Sepic Tank L�-Iitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G id gZ11
Name: (owner) SUBDIVISION LOT # I C,
System Installer: Off -t- Rr -ck L-4 Registration #
Basement with plumbing: ❑ Garage ❑ her of Bedrooms 9
Type of Water Supply: ElCommunity ePublic ElWell Distance from well feet
System Type: q 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.
This system has been installed in
CONDITION -
with applicable North Carolina General Statutes, Rules for Sewage treatment and Uaposal, ana an conattions of the improvement rerm¢ anti construction eumonzation.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No EI
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage Asposal stem on the above captioned property.
Type of system: ❑ Conventional Other Z+FIa vJ
Subsurface No. of exact length
Drainage Field ditches J, of each ditch 70 feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: a gallons Pump Tank: gallons
width of depth of
ditches —3 feet ditches 5 inches
French Drain Required: Linear feet
c
Authorized State Ag t w� �" Date 9
15-, r-,,3 c- 6 ° q