OPHTE#1Z-5- Harnett County Department of Public Health
PERMIT # Operation Pe It 2 2 2 8 8
/New Installation 1? Septic Tank LVC Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,(..1g0-'> ' C Ca. a1b
Name: (owner) J" C' SUBDIVISION ayr~w, r Gt 073 LOT # I
System Installer: Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms
Type of Water Supply: ❑ Community Y Public ❑ Well Distance from well feet
System Type: 21 % Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac 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
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 ❑ PWR Line
Following are the specifications for the sewa e disposavstem on the above captioned property.
Type of system: ❑ Conventional OtherZ-3- la ~t2Ca Septic Tank: 17- O 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 120 feet ditches 3 feet ditches Z-y inches
French Drain Required: Linear feet
Authorized State A Date 2