OPHTE# Q' -5-30030 Harnett County Department of Public Health
PERMIT # 1 �� Operation Permit 22643
New Installation 'X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NiA 2,(_5 ?-�p
Name: (owner) SUBDIVISION N5 ®¢�p LOT # 3Y
System Installer: tc:> s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well YO 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 end Disposal, and all conditions of the Improvement Permit and Construction Authorization
I' Mil LUNVIIIUNN:
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 a
IV. Operation:
maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Y
Subsurface No. of exact length
Drainage Field ditches of each ditch ISO feet
French Drain Required: e�ket
Alarm ❑ 1-12O1-ine ❑ PWR Line
Septic Tank: 000 gallons Pump Tank: gallons
width of depth of 1
ditches feet ditches inches
Authorized State pent V � � r Date 11 9�1
1� 5- mri 3C)