OPHTE# /s S �1n�5,z Harnett County Department of Public Health 23927
PERMIT # ktt!i Operation Per It
New Installation Septic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:' ;d n
Name: (owner) SUBDIVISION LOT # a0
System Installer: OT E:TJ�fr:c Ice cD Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .7
Type of Water Supply: ❑ Community R�' Public ❑ Well Distance from well feet
System Type: -L- 4 Types V and VI Systems expire in S 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 compliance with applicable North Carolina General Statures, Rules for Sewage Treatment and Disposal, 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.
111. 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 sews disposaa��� the above captioned property.
Type of system: El Conventional Other Septic Tank: /600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Fiefd ditches [iv of each ditch $ C) feet ditches 3 feet ditches 2 inches
French Drain Required: Linear feet
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Authorized State Age Date /a>Z /o /2°/f—
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 sews disposaa��� the above captioned property.
Type of system: El Conventional Other Septic Tank: /600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Fiefd ditches [iv of each ditch $ C) feet ditches 3 feet ditches 2 inches
French Drain Required: Linear feet
c p�
Authorized State Age Date /a>Z /o /2°/f—
is's=}65J-z