OPJTE Harnett County Department of Public
PERMIT # �l` Operation Permit
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑Expansion
PROPERTY LOCATION: 4� s�� so re t !-4 f"-/
Name: (owner) Gov uoMe 5 SUBDIVISION� LOT # k
System Installer: C3 ;sis S—IrT Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: a 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 larolma beneral Ntatutes, Rules tar )ewage Ireatment and Ulsposal, and an conditions m the Improvement term¢ ana lonstruC[lon autnonzanon.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 X Other E 2 Si..n".r
Subsurface No. of exact length
Drainage Field � dites, of each ditch 115 feet
French Drain Reauired-- `\ Linear feet
Authorized State
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: 1250 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Date 101 � -V� ) '
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