OPHTE #13- -5-33 Harnett County Department of Public Health
PERMIT # x00 -7 3 Operation Permit 22519
New Installation ";9� Septic Tank )K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: k-4 C,'o O
Name: (owner) SUBDIVISION Gw6 , LOT #
System Installer: cn"�_n� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \ b ® feet
System Type: o, 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.
]his system has been Installed In compliance With applicable north Larollna heneral Mtutes, Rules for sewage Ireatment and UBposal, and all Conditions of the Improvement rermlt and Lonstrin:bon AUtnorizatfon.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other —Z- Q-"j Septic Tank: `Md
Subsurface No. of exact length width of
Drainage Field ditches of each ditch Z-"10 feet ditches 3
French Drain Required: wear feet
Authorized State Agent 'N�"- ���5 Date
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 14, inches