OPHTE #P-5 - 234 5�, Harnett County Department of Public Health
PERMIT # 27 Operation -P -emit 22692
New Installation L'� Septic Tank Z / Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner)1 ! j Qtfj SUBDIVISION LOT #
System Installer: 0;D .7 a, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water"�upply: ❑ Community 2T"'—Public ❑ Well Distance from well feet
System Type: �� �� vl�a Types V and VI Systems expire in 5 years.
(In accordance wit Table V a) Owner must co a Ith Department 6 months prior to expiration for permit renewal.
ims system has peen installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the
Permit and Construction Authorization.
rILmrti wirunivnJ.
I. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 1 24L� feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: 1000 gallons Pump Tank: O 0 gallons
width of depth of
ditches_ feet ditches inches
French Drain Required: Linear feet
Authorized State Ag Q'- Date 9-2--13
mikup"