OPHTE# 14 Harnett County Department of Public Health 23557
PERMIT # I Oteration Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Vp,1ggM
Name: (owner) W�_-_N.t SUBDIVISION Qnmc, LOT #
System Installer: 1'_' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well !db 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.
Inns system nas peen mstauea In compuance wltn appncaole north Larouna ueneral xatutes, awes for sewage Treatment and
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
and an conditions m the
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
rermit and Lonstruttlon Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other �Iu , � ,\,4 Septic Tank: o 0 gallons Pump Tank: i tOC> gallons
Subsurface No. of exact length width of depth of
Drainage Field —ditTiB _'�-�� of each ditch feet ditches feet ditches � `�� inches
French Drain Reauired: Linear feet
Authorized State Agent "� P" Date 3� 311
I,+- 5-35 6°t �