OP RHTE#~JI>~ Harnett County Department of Public Health
PERMIT # aeration Perm ft 21 7 4 7
Z ---New Installation 52" 'Septic Tank Nitrification Line 1:1 Repair ❑ Expansion
PROPERTY LOCATION:, .lt 1/ A, ~ ~ -
Name: (owner) f SUBDIVISION 5- 4,45-~- LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑'Jumber of Bedrooms i
Type of Water Supply: ❑ Community E' Public ❑ Well Distance from well feet
ypes V and VI Systems expire in 5 years.
System Type:" I e>b= t "T
(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 larolma beneral )tatutes, nines for sewage treatment and uisposai, ana an cons Lions of me improvement rermit ana construction numorizarion.
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PERMIT CONDITIONS:
1. 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 ❑ H20Line ❑
Following are the specifications for the sew, disposal system on the above captioned pro,
ri-~~Fseptic ,-:~,,g.4_"~f 4
Type of system: ❑ Conventional Lr Other Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches ZC1
French Drain Required: Linear feet
PWR Line
gallons
inches
Authorized State A¢eoe, ~71,11 1 l i- A7~f Date 2 "lf
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