OPHTE# I6-5-'3SZ58 Harnett County Department of Public Health 24498
PERMIT # 7,69 /0 eration Pe It
d New Installation Septic Tank Nitrification Line ❑ Repair ❑ ExpansioN
�l�N� PROPERTY LO[ATION;�W& S" ✓� nl lR� /�
Name: (owner) �D ` SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Num er of Bedr s Z
Type of Water Supply: ❑ Community ❑ Public Well Distance from well /60 feet
System Type: .,T -G ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PUMP 6 .}INrm 7npGs,// /�
1. Performance: System shall perform i ccordance with Rule .1961.
11. Monitoring: As required by Aul 961.
111. Maintenance: As required b ule .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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine
Following are the specifications for the sew a disposa stem on the above captioned pro try.
Type of system: ❑ Conventional Other �w ]�p ) c_�c'S�a/ Septic Tank 1000 gallons
Subsurface No. of exact length width of 7
Drainage Field ditches Z- of each ditch / 6 feet ditches feet
French Drain Required: Linear feet
0
PWR Line
Pump Tank 1006 gallons
depth of p
ditches inches
Authorized State Agent � _—�;k;;Date / 0/it>1a6r7
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