OPHTE# 3a`5._ 4*'Zy Harnett County Department of Public Health
PERMIT # a4A(aq Operation Permit 2 2 3 3 2
New Installation _j Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: `f'1xs P*D
Name: (owner) R-OR. i~-zflt N-lonE3 SUBDIVISION P1,JNT_FOCZQ LOT # '90
System Installer: 1t✓c~ S"-4 N Registration #
Basement with plumbing: ❑ Garage ~ Number of Bedrooms ~
Type of Water Supply: ❑ Community ~ " Public ❑ Well Distance from well 100 feet
System Type: 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.
finis system nas oeen mstauea in compuance wun appucaoie norm Lamina uenerai statutes, naves for sewage treatment ana msposai, ana an conamons of the
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rermlt ana lonstructlon AUtnorizatlon.
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:
Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the abovff capti d property.
Type of system: ❑ Conventional Other EA- Septic Tank: 100C gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field di ches of each ditch 1.50 feet ditches 31 feet ditches AL) "30 inches
French Drain Reauired. feet
Authorized State Agent ,y - 112 ~ 5 Date