OPHTE# Ja'rD-`-M;3 Harnett County Department of Public Health
PERMIT # D-(-' T15 Operation Permit 2 2 3 3 4
New Installation X Septic Tank )j Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N vczsGCZy'~
Name: (owner) >,•,i, l-P"y 34 S;N, SUBDIVISION tog ,oN, LOT #
System Installer: Noc-oc~ C-a tD'~N c. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L)
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Lb7 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.
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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1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
H20Line ❑ PWR Line
Following are the spec
ifications for the sewage dispos
al system on the above capti property.
Type of system: ❑
Conventional X Other
f yrr+p w Septic Tank: t
gallons Pump Tank: 1000 gallons
Subsurface
No. of--•--_
exact length width of
depth of
Drainage Field
French Drain Required:
ditches of each ditch Jc- O feet ditches
-31
ioear
feet ditches inches
Authorized State Agent y N., 4h5 Date 616