OPHTE# iz- 9 V5 Y Harnett County Department of Public Health
PERMIT # Z7 NJ Operation Permit 22397
E New Installation 5 Septic Tank Er Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: k �,t ,4 -le Xd.
Name: (owner) c A c 13u < < deaf SUBDIVISION / LOT #
System Installer: —S 6 i Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community I�-Public ❑ Well Distance from well feet
System Type: 'TEL 119 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.
Ims system nas been Installed In compliance with applicable North laralma beneral Ntatutes, Rules for )ewage Ireatment and Ulsposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
R
L
1
C
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No E2"'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
r tAck
❑
lie
Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sews dispos
t
system on the above captioned property.
Type of system:
El Conventional Other —�^M
k L Z) /aw Septic Tank:
NUU gallons Pump Tank: MOO gallons
d
No. of
exact length width of
1
Drainage Field
ditches
of each ditch ISTO feet ditches
feet ditches 30 "/d inches
c_
d
Im IC)
❑
D -Box ❑
Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sews dispos
t
system on the above captioned property.
Type of system:
El Conventional Other —�^M
k L Z) /aw Septic Tank:
NUU gallons Pump Tank: MOO gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch ISTO feet ditches
feet ditches 30 "/d inches
French Drain Required: linear feet /
Authorized State Age %t�� le'- Date t(
�-- r =,ZY fY- (