OPHTE #_�_ -5__3C) W59 Harnett County Department of Public Health
PERMIT # Operation Permit 22637
New Installation X Septic Tank Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: OL-it, U5 411
Name: (owner) ts- %N S,�d ` �7 LocL SUBDIVISION LOT #
System Installer: Cu-su -p vatva Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t T' d feet
System Type: =t 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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PERMII CONDIIIUNS:
I. 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 ❑
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El Conventional Other aZ F�_ow
Subsurface No. of exact length
Drainage Field ditches of each ditch 100 feet
French Dras'n RRmred_� __ Linear feet
Authorized State Age
Alarm ❑
Septic Tank:
width of
ditches
H2OLine ❑
PWR Line
io ®G gallons Pump Tank: gallons
depth of
3 feet ditches ail' 30 inches
Date 4-I3lI
� 3- 5.-30 � 5 °�